Provider Demographics
NPI:1376693168
Name:KOOS, VICTORIA MARKOVITS (LAC MTOM)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARKOVITS
Last Name:KOOS
Suffix:
Gender:F
Credentials:LAC MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 FORT WASHINGTON AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3532
Mailing Address - Country:US
Mailing Address - Phone:917-202-5356
Mailing Address - Fax:
Practice Address - Street 1:265 W 37TH ST RM 640
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5762
Practice Address - Country:US
Practice Address - Phone:917-202-5356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2744171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist