Provider Demographics
NPI:1477506418
Name:NIKIRK, VICTOR DALE (OTR OPA-C)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:DALE
Last Name:NIKIRK
Suffix:
Gender:M
Credentials:OTR OPA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:576 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6003
Mailing Address - Country:US
Mailing Address - Phone:631-376-0318
Mailing Address - Fax:631-376-0319
Practice Address - Street 1:285 SILLS ROAD
Practice Address - Street 2:BLDG 18
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4808
Practice Address - Country:US
Practice Address - Phone:631-475-1224
Practice Address - Fax:631-475-1224
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQU050Q5VS1Medicare PIN