| Victory Medical Clinic Llc | |
|
433 Sand Shore Rd Hackettstown NJ 07840-5504 | |
| (862) 254-2299 | |
| (862) 254-2300 |
| Full Name | Victory Medical Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 433 Sand Shore Rd, Hackettstown, New Jersey |
| Authorized Official Name and Position | Augustine Okpala (HEALTHCARE PROFESSIONAL) |
| Authorized Official Contact | 8622542299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Medical Clinic Llc 433 Sand Shore Rd Hackettstown NJ 07840-5504 Ph: (862) 254-2299 | Victory Medical Clinic Llc 433 Sand Shore Rd Hackettstown NJ 07840-5504 Ph: (862) 254-2299 |
| NPI Number | 1013367465 |
|---|---|
| Provider Enumeration Date | 06/16/2016 |
| Last Update Date | 06/16/2016 |
| Medicare PECOS PAC ID | 8224324843 |
|---|---|
| Medicare Enrollment ID | O20160908000934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013367465 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA08035200 (New Jersey) | Primary |
| Provider Name | Augustine C Okpala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124085766 PECOS PAC ID: 0941213466 Enrollment ID: I20060728000048 |
| Provider Name | Nkemamaka C Okpala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992062749 PECOS PAC ID: 2163651308 Enrollment ID: I20140210000760 |
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