Provider Demographics
NPI:1477865616
Name:VICTORY OBSTETRICS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:VICTORY OBSTETRICS & GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAPORTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-981-5900
Mailing Address - Street 1:78 CROMWELL AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3933
Mailing Address - Country:US
Mailing Address - Phone:718-981-5900
Mailing Address - Fax:718-273-9589
Practice Address - Street 1:78 CROMWELL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3933
Practice Address - Country:US
Practice Address - Phone:718-981-5900
Practice Address - Fax:718-273-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-03
Last Update Date:2010-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199593207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01710136Medicaid
G40120Medicare UPIN