Organization
VICTORY MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J LACQUA MD (OWNER)
(781) 761-3700
Entity
Organization
Contact information
Practice address
2372 VICTORY BLVD, STATEN ISLAND, NY 10314-6607
(781) 761-3700
(718) 698-3090
Mailing address
2372 VICTORY BLVD, STATEN ISLAND, NY 10314-6607
(781) 761-3700
(718) 698-3090
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
07/15/2024
Last updated
07/15/2024
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