Healthcare Provider Details

I. General information

NPI: 1992859904
Provider Name (Legal Business Name): VICTORIA MINIOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 2750S
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 BRADHURST AVE STE 2750S
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-2280
  • Fax: 914-493-2060
Mailing address:
  • Phone: 914-493-2280
  • Fax: 914-493-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number216530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: