Provider Demographics
NPI:1053493197
Name:BELENKOVA, VIKTORYA (OD)
Entity Type:Individual
Prefix:
First Name:VIKTORYA
Middle Name:
Last Name:BELENKOVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 PENNSYLVANIA AVE
Mailing Address - Street 2:APT 7H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2617
Mailing Address - Country:US
Mailing Address - Phone:212-719-4000
Mailing Address - Fax:
Practice Address - Street 1:2 W 47TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-3319
Practice Address - Country:US
Practice Address - Phone:212-719-4000
Practice Address - Fax:212-382-2123
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY6579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C224B1Medicare PIN
NYU92409Medicare UPIN