Provider Demographics
NPI:1730331141
Name:VICTORY MEDICINE PC
Entity type:Organization
Organization Name:VICTORY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEPIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-815-2299
Mailing Address - Street 1:25 VICTORY BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2905
Mailing Address - Country:US
Mailing Address - Phone:718-815-7246
Mailing Address - Fax:516-706-1085
Practice Address - Street 1:25 VICTORY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2905
Practice Address - Country:US
Practice Address - Phone:718-815-7246
Practice Address - Fax:516-706-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1480542084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Multi-Specialty