Active NPI
Victory Podiatry Associate PLLC
- Podiatrist
- Staten Island, NY
National Provider Identifier
1952472516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- N002642
- Legal business name
- VICTORY PODIATRY ASSOCIATE PLLC
- Practice address
- 2305 Victory Blvd
Staten Island, NY 10314-6623 - Phone
- (718) 761-6665
- Fax
- (718) 761-3074
- NPI assigned
- Nov 13, 2006
- Last updated
- Jan 8, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Phyllis Nancy Merlino
- Title
- DPM
- Phone
- (718) 761-6665
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | N002642 | NY | Primary |
Addresses
Primary practice location
2305 Victory Blvd
Staten Island, NY 10314-6623
Mailing address
2305 Victory Blvd
Staten Island, NY 10314-6623
Phone (718) 761-6665
Other names 1
- Victory Podiatry Associates pllc
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 2
National Provider Directory
National Provider DirectoryLocations
2305 Victory Blvd
Staten Island, NY 10314
Phone (718) 761-6665
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Podiatrist
- Staten Island, NY
- NPI 1497867725
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1546905600000",
"number": "1952472516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2305 VICTORY BLVD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103146623",
"telephone_number": "718-761-6665",
"fax_number": "718-761-3074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2305 VICTORY BLVD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103146623",
"telephone_number": "718-761-6665",
"fax_number": "718-761-3074"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VICTORY PODIATRY ASSOCIATE PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-13",
"last_updated": "2019-01-08",
"status": "A",
"authorized_official_last_name": "MERLINO",
"authorized_official_first_name": "PHYLLIS",
"authorized_official_middle_name": "NANCY",
"authorized_official_title_or_position": "DPM",
"authorized_official_telephone_number": "718-761-6665"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NY",
"license": "N002642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Victory Podiatry Associates pllc",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; 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.