NPIMap

Organization Active NPI

Baker Victory Healthcare Center

  • Pediatrics Physician
  • Lackawanna, NY
National Provider Identifier
1538082821
Registry record updated Aug 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
BAKER VICTORY HEALTHCARE CENTER
Practice address
790 Ridge Rd FL 1
Lackawanna, NY 14218-1629
Phone
(716) 893-7337
NPI assigned
Aug 3, 2026
Organization subpart
Yes
Parent organization
BAKER VICTORY HEALTHCARE CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 3, 2026

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

Authorized official

Name
Amy Destro
Title
Credentialing Specialist
Phone
(716) 343-5566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

790 Ridge Rd FL 1
Lackawanna, NY 14218-1629

Mailing address

790 Ridge Rd
Lackawanna, NY 14218-1629
Phone (716) 343-5566

National Provider Directory

National Provider Directory
Tax ID family
Baker Victory Healthcare Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

790 Ridge Rd
Fl 1
Lackawanna, NY 14218
Phone (716) 893-7337

Practitioners & affiliated clinicians

Practitioners 5

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": "1785715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785715200000",
    "number": "1538082821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 RIDGE RD",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181629",
            "telephone_number": "716-343-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 RIDGE RD FL 1",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181629",
            "telephone_number": "716-893-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAKER VICTORY HEALTHCARE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAKER VICTORY HEALTHCARE CENTER",
        "enumeration_date": "2026-08-03",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A",
        "authorized_official_last_name": "DESTRO",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "716-343-5566"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lackawanna, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; 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.