Provider Demographics
NPI:1669489365
Name:VICTOR, STEVEN ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLAN
Last Name:VICTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 PARK AVE FL 17
Mailing Address - Street 2:17TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1860
Mailing Address - Country:US
Mailing Address - Phone:212-249-3050
Mailing Address - Fax:212-202-4080
Practice Address - Street 1:460 PARK AVENUE
Practice Address - Street 2:17TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-249-3050
Practice Address - Fax:212-202-4080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138656174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
133019950OtherPHCS
NS189OtherOXF
41671OtherUHC
10596OtherGHI
1081758OtherAETNA
1081758OtherAETNA
133019950OtherPHCS