Provider Demographics
NPI:1407242555
Name:VIKTORIYA MEDICAL PLLC
Entity Type:Organization
Organization Name:VIKTORIYA MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR.
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKTORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-837-4466
Mailing Address - Street 1:PO BOX 2188
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:261 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1216
Practice Address - Country:US
Practice Address - Phone:718-837-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2013071208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty