Individual provider Active NPI

Victoria Van Wie, MA CCC-SLP

  • Speech-Language Pathologist
  • Huntington, NY
National Provider Identifier
1366023640
Registry record updated Apr 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
029643 Issued in NY
Practice address
7 High St Ste 102
Huntington, NY 11743-7605
Phone
(631) 423-7700
NPI assigned
Apr 18, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 029643 NY Primary

Addresses

Primary practice location

7 High St Ste 102
Huntington, NY 11743-7605

Mailing address

170 Highwood Cir
Oyster Bay, NY 11771-3206
Phone (516) 474-8464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241105000357 NY Practitioner - Qualified Speech Language Pathologist 3072046655 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
029643NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Aug 29, 2024 Accepting new patients
North Shore - Lij Medical PC CurrentSince Aug 29, 2024 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

430 Lakeville Rd
North New Hyde Park, NY 11042
Phone (718) 470-7550

300 Community Dr
Plandome, NY 11030

221 Jericho Tpke
#1N
Syosset, NY 11791
Phone (516) 496-6582

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1618704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618704000000",
    "number": "1366023640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 HIGHWOOD CIR",
            "city": "OYSTER BAY",
            "state": "NY",
            "postal_code": "117713206",
            "telephone_number": "516-474-8464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 HIGH ST STE 102",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117437605",
            "telephone_number": "631-423-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WIE",
        "first_name": "VICTORIA",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-18",
        "last_updated": "2021-04-18",
        "certification_date": "2021-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "029643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.