Provider Demographics
NPI:1437806502
Name:VICTOR DERMATOLOGY PC
Entity Type:Organization
Organization Name:VICTOR DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIF
Authorized Official - Middle Name:F
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-222-1400
Mailing Address - Street 1:7400 PITTSFORD VICTOR RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9725
Mailing Address - Country:US
Mailing Address - Phone:585-222-1400
Mailing Address - Fax:
Practice Address - Street 1:7400 PITTSFORD VICTOR RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9725
Practice Address - Country:US
Practice Address - Phone:585-222-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty