Healthcare Provider Details

I. General information

NPI: 1477155943
Provider Name (Legal Business Name): ISABELLA VICTORIA SKOMIAL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E 38TH ST
NEW YORK NY
10016-2772
US

IV. Provider business mailing address

2150 GREENE AVE
RIDGEWOOD NY
11385-1962
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-7070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: