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General NPI Number Information
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NPI Number | 1902460124
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Entity Type | Organization
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Legal Business Name | VICTORY MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 129 CENTRAL PARK N
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City | NEW YORK
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State | NY
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Zip | 10026-4201
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Country | US
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Telephone | 914-331-0820
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Fax | 888-443-9088
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Provider Business Mailing Address
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Address Line | 129 CENTRAL PARK N
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City | NEW YORK
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State | NY
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Zip | 10026-4201
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Country | US
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Telephone | 914-331-0820
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Fax | 888-443-9088
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Authorized Official
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Title or Position | MANAGER
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Name | YAAKOV GRUN
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Credential |
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Telephone | 845-395-4071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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