Provider Demographics
NPI:1922085067
Name:BEYDA, VICTORIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:BEYDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11557
Mailing Address - Country:US
Mailing Address - Phone:516-569-9731
Mailing Address - Fax:
Practice Address - Street 1:4334 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2412
Practice Address - Country:US
Practice Address - Phone:212-927-1717
Practice Address - Fax:212-927-3453
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2318152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02591986Medicaid
NY02591986Medicaid
NY05517XMedicare PIN
NY06544KMedicare PIN
NYI05174Medicare UPIN
NY07075GMedicare PIN