Provider Demographics
NPI:1437489473
Name:GOY, VIKTOR I
Entity Type:Individual
Prefix:MR
First Name:VIKTOR
Middle Name:I
Last Name:GOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 N. CHURCH RD.
Mailing Address - Street 2:P.O. BOX 874999
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4999
Mailing Address - Country:US
Mailing Address - Phone:907-373-6747
Mailing Address - Fax:907-373-3036
Practice Address - Street 1:2935 N. CHURCH RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99687-4999
Practice Address - Country:US
Practice Address - Phone:907-373-6747
Practice Address - Fax:907-373-3036
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK936863320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities