Provider Demographics
NPI:1467622159
Name:VICTOR, LAURA N (RPAC)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:N
Last Name:VICTOR
Suffix:
Gender:F
Credentials:RPAC
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Mailing Address - Street 1:222 ROCKAWAY TPKE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1833
Mailing Address - Country:US
Mailing Address - Phone:516-239-1800
Mailing Address - Fax:516-239-5553
Practice Address - Street 1:222 ROCKAWAY TPKE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1833
Practice Address - Country:US
Practice Address - Phone:516-239-1800
Practice Address - Fax:516-239-5553
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2010-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY12347363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant