Provider Demographics
NPI:1407865454
Name:MUCHNIK, VICTORYA NECHAMA (DPM)
Entity Type:Individual
Prefix:DR
First Name:VICTORYA
Middle Name:NECHAMA
Last Name:MUCHNIK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6514
Mailing Address - Country:US
Mailing Address - Phone:718-645-6705
Mailing Address - Fax:718-645-6707
Practice Address - Street 1:1795 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6514
Practice Address - Country:US
Practice Address - Phone:718-645-6705
Practice Address - Fax:718-645-6707
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005636213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02128178Medicaid
PB3742Medicare PIN
U78533Medicare UPIN
NY02128178Medicaid