Healthcare Provider Details

I. General information

NPI: 1053235598
Provider Name (Legal Business Name): VICTORIA ETLIN-KISHKIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 KINGS HWY APT 1J
BROOKLYN NY
11234-2622
US

IV. Provider business mailing address

249 13TH ST APT 18
BROOKLYN NY
11215-4846
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-4067
  • Fax: 718-676-4068
Mailing address:
  • Phone: 347-276-9960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF312354-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: