Provider Demographics
NPI:1003464587
Name:MISYUK, VICTOR BRIAN (LMT)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:BRIAN
Last Name:MISYUK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 COOPER ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-6427
Mailing Address - Country:US
Mailing Address - Phone:646-886-0586
Mailing Address - Fax:
Practice Address - Street 1:274 COOPER ST APT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-6427
Practice Address - Country:US
Practice Address - Phone:646-886-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist