Provider Demographics
NPI:1518210194
Name:MERAGLIA, VICTORIA
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:MERAGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:BAMBINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13 W MILL DR
Mailing Address - Street 2:APT 3A
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4069
Mailing Address - Country:US
Mailing Address - Phone:516-884-2908
Mailing Address - Fax:
Practice Address - Street 1:13 W MILL DR
Practice Address - Street 2:APT 3A
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4069
Practice Address - Country:US
Practice Address - Phone:516-884-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY844673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist