Healthcare Provider Details

I. General information

NPI: 1689558256
Provider Name (Legal Business Name): VICTORIA GAITINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 BROADWAY STE A
MASSAPEQUA NY
11758-5031
US

IV. Provider business mailing address

18 KNELL DR
MASSAPEQUA PARK NY
11762-4014
US

V. Phone/Fax

Practice location:
  • Phone: 516-716-3876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF354745
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: