Organization
VICTORY MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JUDE LACQUA M.D. (MEDICAL DOCTOR)
(718) 761-3700
Entity
Organization
Contact information
Practice address
2372 VICTORY BLVD, STATEN ISLAND, NY 10314-6607
(718) 761-3700
(718) 698-3090
Mailing address
2372 VICTORY BLVD, STATEN ISLAND, NY 10314-6607
(718) 761-3700
(718) 698-3090
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
192446
NY
2086S0105X
Surgery of the Hand (Surgery) Physician
192446
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992753883
NPI
NY
Enumeration date
12/09/2013
Last updated
04/09/2015
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