Provider Demographics
NPI:1881401396
Name:JEAN, VICTORIA C
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:C
Last Name:JEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3717
Mailing Address - Country:US
Mailing Address - Phone:845-634-6677
Mailing Address - Fax:845-307-6609
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3717
Practice Address - Country:US
Practice Address - Phone:845-634-6677
Practice Address - Fax:845-307-6609
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist