Provider Demographics
NPI:1902986821
Name:KIRSCH, VICTORIA SUSAN (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:SUSAN
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5 RIDGEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4315
Mailing Address - Country:US
Mailing Address - Phone:973-669-0750
Mailing Address - Fax:973-669-0750
Practice Address - Street 1:201 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2141
Practice Address - Country:US
Practice Address - Phone:973-324-3668
Practice Address - Fax:973-324-3695
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217260208100000X
NJ25MB08062000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid
NY0033T128Medicare ID - Type Unspecified