MEDICARE: VICTORIA GARDNER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	021660	NY

General Provider Information

NPI Number	:	1285141531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA GARDNER PA-C

Provider Business Mailing Address
First Line	:	3333 NEW HYDE PARK RD STE 101
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1205
Country	:	US
Telephone Number	:	516-414-5865
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 NEW HYDE PARK RD STE 101
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1205
Country	:	US
Telephone Number	:	516-414-6900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	02/05/2026

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