Healthcare Provider Details

I. General information

NPI: 1265134258
Provider Name (Legal Business Name): VICTORIA RENEE WOOD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

2796 MAPLE RIDGE DR
WOODBRIDGE VA
22192-3807
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7000
  • Fax:
Mailing address:
  • Phone: 703-357-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102210053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: