Victory Medical PLLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

VICTORY MEDICAL PLLC

Practice address

2372 Victory Blvd
Staten Island, NY 10314-6607

Phone

(781) 761-3700

Fax

(718) 698-3090

NPI assigned

Jul 15, 2024

Last updated

Jul 15, 2024By 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

Michael J Lacqua, MDNPI 1992753883

Title

Owner

Phone

(781) 761-3700

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Jude Lacqua, MD

  • Plastic Surgery Physician
  • Staten Island, NY
  • NPI 1992753883
  Authorized official Same address or phone

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

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1922845007",
    "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": "781-761-3700",
            "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": "781-761-3700",
            "fax_number": "718-698-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-15",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "LACQUA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-761-3700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victory Dental PLLC
• Victory Family Pharmacy, LLC (The Apothecary Shoppe)
• Victory Internal Medicine, P.C.
• Victory Medical Group PLLC
• Victory Medical PLLC
• Victory Medical Services PLLC
• Victory Medical Supplies Inc
• Victory Medicine PC
• Victory Obstetrics & Gynecology PC
• Victory Physical Therapy, P.C.

• Plastic Surgery Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Plastic Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.