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General NPI Number Information
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NPI Number | 1396245312
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Entity Type | Individual
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Provider Name | ENRIQUE N VICTORIA JR. NP-C
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Gender | Male
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 325 MARTIN RD
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City | UNION
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State | NJ
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Zip | 07083-7947
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Country | US
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Telephone | 646-244-2726
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Fax |
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Provider Business Mailing Address
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Address Line | 325 MARTIN RD
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City | UNION
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State | NJ
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Zip | 07083-7947
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Country | US
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Telephone | 646-244-2726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F01180986
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License Number State | NJ
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