Provider Demographics
NPI:1558158402
Name:CHEBOTAR, VIKTORIIA
Entity type:Individual
Prefix:
First Name:VIKTORIIA
Middle Name:
Last Name:CHEBOTAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CANVASBACK RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3659
Mailing Address - Country:US
Mailing Address - Phone:347-652-8083
Mailing Address - Fax:
Practice Address - Street 1:11 CANVASBACK RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3659
Practice Address - Country:US
Practice Address - Phone:347-652-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCERTIFIED174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist