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Organization
VICTORY INTERNAL MEDICINE, P.C.
Active
Organization
VICTORY INTERNAL MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHYE WORTMAN M.D. (PRESIDENT)
(718) 477-6900
Entity
Organization
Contact information
Practice address
2315 VICTORY BLVD, STATEN ISLAND, NY 10314-6623
(718) 477-6900
Mailing address
2315 VICTORY BLVD, STATEN ISLAND, NY 10314-6623
(718) 477-6900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
201641
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2294955
AETNA HMO GROUP#
NY
01
—
7585094
AETNA PPO GROUP#
NY
01
—
CJ9386
RAILROAD MEDICARE GROUP#
NY
Enumeration date
07/04/2006
Last updated
04/20/2008
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