Victory NP in Psychiatry, PC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

401152 Issued in NY

Legal business name

VICTORY NP IN PSYCHIATRY, PC

Practice address

2962 Wickham Ave
Bronx, NY 10469-3324

Phone

(646) 384-0252

NPI assigned

Apr 2, 2016

Organization subpart

Yes

Parent organization

N/AAs reported in NPPES

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

Authorized official

Name

Mr. Godwin McMukoro Okpomo Sr., NURSE PRACTITIONERNPI 1043696750

Title

Clinical Director

Phone

(646) 384-0252

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• N/A Former legal business name

Part of

Victory NP in Psychiatry PC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• N/a

  • Physical Therapy Clinic/Center
  • Staten Island, NY
  • NPI 1134676588
  NPPES parent name

Practitioners 1

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

• Godwin Okpomo Sr., NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bronx, NY
  • NPI 1043696750
  NPD (past) Authorized official

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

{
    "created_epoch": "1459555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459555200000",
    "number": "1093178428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2962 WICKHAM AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104693324",
            "telephone_number": "646-384-0252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2962 WICKHAM AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104693324",
            "telephone_number": "646-384-0252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY NP IN PSYCHIATRY, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "N/A",
        "enumeration_date": "2016-04-02",
        "last_updated": "2016-04-02",
        "status": "A",
        "authorized_official_last_name": "OKPOMO",
        "authorized_official_first_name": "GODWIN",
        "authorized_official_middle_name": "MCMUKORO",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "646-384-0252",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "401152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1043696750",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Juana Victoria, LMSW
• Victory Seventh-Day Adventist Church
• Emerald Jane Vidad
• Juan Francisco Vidal Moreno, MD
• Iris Vidal, LMSW
• Kayla Masha Vidal, ARNP

• Psychiatric/Mental Health Nurse Practitioner in Bronx, NY
• Providers in Bronx, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2016; 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.