Healthcare Provider Details

I. General information

NPI: 1083669915
Provider Name (Legal Business Name): VICTORIA VAMOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 COATES AVE STE 31
HOLBROOK NY
11741-6039
US

IV. Provider business mailing address

751 COATES AVE STE 31
HOLBROOK NY
11741-6039
US

V. Phone/Fax

Practice location:
  • Phone: 631-580-0000
  • Fax: 631-580-0001
Mailing address:
  • Phone: 631-580-0000
  • Fax: 631-580-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number333441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: