Healthcare Provider Details

I. General information

NPI: 1053184481
Provider Name (Legal Business Name): VICTORIA BONDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 NARROWS RD N APT B
STATEN ISLAND NY
10305-2850
US

IV. Provider business mailing address

109 DELANCEY ST
NEW YORK NY
10002-3275
US

V. Phone/Fax

Practice location:
  • Phone: 718-510-7467
  • Fax:
Mailing address:
  • Phone: 212-614-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number666912
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: