Provider Demographics
NPI:1952330094
Name:ZELEK, VICTOR (PHD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:ZELEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W BARD AVE
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1109
Mailing Address - Country:US
Mailing Address - Phone:646-831-4882
Mailing Address - Fax:845-876-8850
Practice Address - Street 1:22 GARDEN ST
Practice Address - Street 2:SUITE #4
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1300
Practice Address - Country:US
Practice Address - Phone:845-876-8845
Practice Address - Fax:845-876-8850
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013910-1103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY394072OtherMVP HEALTHCARE INSURANCE
NYVS0901Medicare ID - Type Unspecified
NY394072OtherMVP HEALTHCARE INSURANCE