Provider Demographics
NPI:1760687578
Name:FOGEL, VICTORYA (MS, LNS)
Entity Type:Individual
Prefix:
First Name:VICTORYA
Middle Name:
Last Name:FOGEL
Suffix:
Gender:F
Credentials:MS, LNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 E 18TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3622
Mailing Address - Country:US
Mailing Address - Phone:718-332-0080
Mailing Address - Fax:718-332-3365
Practice Address - Street 1:2610 E 18TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3622
Practice Address - Country:US
Practice Address - Phone:718-332-0080
Practice Address - Fax:718-332-3365
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005150133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist