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General NPI Number Information
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NPI Number | 1245698489
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Entity Type | Organization
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Legal Business Name | MIH VICTORY INC
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 311 AUDUBON AVE FL 2
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City | NEW YORK
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State | NY
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Zip | 10033-4237
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Country | US
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Telephone | 212-256-0725
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Fax | 917-261-4704
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Provider Business Mailing Address
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Address Line | 311 AUDUBON AVE FL 2
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City | NEW YORK
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State | NY
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Zip | 10033-4237
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Country | US
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Telephone | 212-256-0725
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Fax | 917-261-4704
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Authorized Official
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Title or Position | DIRECTOR
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Name | ERCILIA GARCIA
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Credential |
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Telephone | 212-256-0725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 170111976
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License Number State | NY
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