Provider Demographics
NPI:1639243751
Name:VICTORIA PHYSICAL MEDICINE PC
Entity Type:Organization
Organization Name:VICTORIA PHYSICAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-966-9818
Mailing Address - Street 1:53 ELIZABETH ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4623
Mailing Address - Country:US
Mailing Address - Phone:212-966-9818
Mailing Address - Fax:212-966-9189
Practice Address - Street 1:53 ELIZABETH ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4623
Practice Address - Country:US
Practice Address - Phone:212-966-9818
Practice Address - Fax:212-966-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03195402Medicaid
WES681Medicare PIN