Victory Family Wellness LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

Legal business name

VICTORY FAMILY WELLNESS LLC

Practice address

1812 Quentin Rd Ste M2
Brooklyn, NY 11229-1336

Phone

(347) 443-3707

Fax

(917) 791-9110

NPI assigned

Sep 20, 2022

Last updated

Sep 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Larissa Jerominow, AGPCNP

Title

Owner

Phone

(347) 443-3707

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1205559812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 QUENTIN RD STE M2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291336",
            "telephone_number": "347-443-3707",
            "fax_number": "917-791-9110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 QUENTIN RD STE M2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291336",
            "telephone_number": "347-443-3707",
            "fax_number": "917-791-9110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY FAMILY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-20",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "JEROMINOW",
        "authorized_official_first_name": "LARISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-443-3707",
        "authorized_official_credential": "AGPCNP"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Gerontology Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.