Provider Demographics
NPI:1093070823
Name:SMITH, VICTORIA G (MS)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SARINA DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1806
Mailing Address - Country:US
Mailing Address - Phone:631-858-1772
Mailing Address - Fax:
Practice Address - Street 1:16 SARINA DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1806
Practice Address - Country:US
Practice Address - Phone:631-858-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2163191174400000X
1116407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist