Healthcare Provider Details

I. General information

NPI: 1184607590
Provider Name (Legal Business Name): VICTOR DLUGASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE STE 115
ROCKVILLE CENTER NY
11570-3761
US

IV. Provider business mailing address

165 N VILLAGE AVE STE 115
ROCKVILLE CENTER NY
11570-3761
US

V. Phone/Fax

Practice location:
  • Phone: 516-764-7660
  • Fax: 516-764-7882
Mailing address:
  • Phone: 516-764-7660
  • Fax: 516-764-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number126468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: