MEDICARE: VICTORY MEDICAL REHAB, P.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	208VP0000X	Pain Medicine Physician	167572	NY

General Provider Information

NPI Number	:	1942639976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY MEDICAL REHAB, P.C.

Provider Business Mailing Address
First Line	:	1659 78TH ST
Second Line	:	SUITE 2D
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1011
Country	:	US
Telephone Number	:	718-234-1212
Fax Number	:	718-234-1164

Provider Business Practice Location Address
First Line	:	1659 78TH ST
Second Line	:	SUITE 2D
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1011
Country	:	US
Telephone Number	:	718-234-1212
Fax Number	:	718-234-1164

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. YEKATERINA FILL SLUKHINSKY
Credential	:	MD
Telephone Number	:	718-234-1212

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	11/12/2013

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