Healthcare Provider Details

I. General information

NPI: 1033738174
Provider Name (Legal Business Name): NIKASVIKAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 OCEAN AVE APT 6F
BROOKLYN NY
11229-2336
US

IV. Provider business mailing address

2249 OCEAN AVE APT 6F
BROOKLYN NY
11229-2336
US

V. Phone/Fax

Practice location:
  • Phone: 718-801-1778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA MALMYGIN
Title or Position: PRESIDENT
Credential: MS ED, BCBA,NYS LBA
Phone: 718-801-1778