Provider Demographics
NPI:1942639976
Name:VICTORY MEDICAL REHAB, P.C.
Entity Type:Organization
Organization Name:VICTORY MEDICAL REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YEKATERINA
Authorized Official - Middle Name:FILL
Authorized Official - Last Name:SLUKHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-234-1212
Mailing Address - Street 1:1659 78TH ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1011
Mailing Address - Country:US
Mailing Address - Phone:718-234-1212
Mailing Address - Fax:718-234-1164
Practice Address - Street 1:1659 78TH ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1011
Practice Address - Country:US
Practice Address - Phone:718-234-1212
Practice Address - Fax:718-234-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167572208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty