=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659532752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR.VIKTOR BRIKER P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2008
-----------------------------------------------------
Last Update Date | 06/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 842 RED LION RD STE 18
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19115-1475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-856-9810
-----------------------------------------------------
Fax | 215-856-9820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 842 RED LION RD STE 18
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19115-1475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-856-9810
-----------------------------------------------------
Fax | 215-856-9820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VIKTOR BRIKER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 215-355-6197
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 0EG000084
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------