Healthcare Provider Details

I. General information

NPI: 1114822400
Provider Name (Legal Business Name): VICTORY MEDICAL OF MARYLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 HILLTOP PL
MONSEY NY
10952-2809
US

IV. Provider business mailing address

19 HILLTOP PL
MONSEY NY
10952-2809
US

V. Phone/Fax

Practice location:
  • Phone: 917-599-9655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RICHARD DANIELS
Title or Position: OWNER
Credential: MD
Phone: 732-598-4226