Provider Demographics
NPI:1235104076
Name:REESMAN, VICTORIA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:REESMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:KYRIAKOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:SUITE 5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-3491
Mailing Address - Fax:
Practice Address - Street 1:6010 BAY PKWY STE 901
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6081
Practice Address - Country:US
Practice Address - Phone:718-238-2100
Practice Address - Fax:718-748-0863
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301797363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02474275Medicaid
NY0952G1Medicare ID - Type Unspecified
NY02474275Medicaid