Provider Demographics
NPI:1750645313
Name:MIROSH, VICTORIA K
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:K
Last Name:MIROSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 153RD ST APT 249
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3099
Mailing Address - Country:US
Mailing Address - Phone:347-209-9454
Mailing Address - Fax:
Practice Address - Street 1:7525 153RD ST APT 249
Practice Address - Street 2:
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-3099
Practice Address - Country:US
Practice Address - Phone:347-209-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator