Provider Demographics
NPI:1194005520
Name:TOLENTINO, VICTORIO R JR (PMHNP-BC, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:VICTORIO
Middle Name:R
Last Name:TOLENTINO
Suffix:JR
Gender:M
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 BROADWAY
Mailing Address - Street 2:NEW YORK UNIVERSITY STUDENT HEALTH CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-998-4780
Mailing Address - Fax:
Practice Address - Street 1:726 BROADWAY
Practice Address - Street 2:NEW YORK UNIVERSITY STUDENT HEALTH CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-998-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337007363LF0000X
NY401687363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily