NPIMap

Organization Active NPI

Victory Medical PLLC

  • Plastic Surgery Physician
  • Staten Island, NY
National Provider Identifier
1013348689
Registry record updated Apr 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
192446 Issued in NY
Legal business name
VICTORY MEDICAL PLLC
Practice address
2372 Victory Blvd
Staten Island, NY 10314-6607
Phone
(718) 761-3700
Fax
(718) 698-3090
NPI assigned
Dec 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Jude Lacqua, M.D.NPI 1992753883
Title
Medical Doctor
Phone
(718) 761-3700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X 192446 NY Primary
Surgery of the Hand (Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0105X 192446 NY

Addresses

Primary practice location

2372 Victory Blvd
Staten Island, NY 10314-6607

Mailing address

2372 Victory Blvd
Staten Island, NY 10314-6607
Phone (718) 761-3700

Other identifiers 1

IdentifierTypeStateIssuer
1992753883OtherNYNPI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1013348689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2372 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146607",
            "telephone_number": "718-761-3700",
            "fax_number": "718-698-3090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2372 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146607",
            "telephone_number": "718-761-3700",
            "fax_number": "718-698-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "LACQUA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JUDE",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "718-761-3700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "NY",
            "license": "192446",
            "primary": true
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgery of the Hand",
            "state": "NY",
            "license": "192446",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1992753883",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.