| Victory Medical Group Pllc | |
|
220 Victory Blvd Staten Island NY 10301-2919 | |
| (718) 447-1080 | |
| (718) 447-1559 |
| Full Name | Victory Medical Group Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 220 Victory Blvd, Staten Island, New York |
| Authorized Official Name and Position | Omar Klobocista (MEDICAL DOCTOR) |
| Authorized Official Contact | 3476980710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Medical Group Pllc 220 Victory Blvd Staten Island NY 10301-2919 Ph: (718) 447-1080 | Victory Medical Group Pllc 220 Victory Blvd Staten Island NY 10301-2919 Ph: (718) 447-1080 |
| NPI Number | 1912223280 |
|---|---|
| Provider Enumeration Date | 04/12/2010 |
| Last Update Date | 01/12/2022 |
| Medicare PECOS PAC ID | 7810307055 |
|---|---|
| Medicare Enrollment ID | O20201029001634 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912223280 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 255828 (New York) | Primary |
| Provider Name | Omar Klobocista |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093040115 PECOS PAC ID: 2264568948 Enrollment ID: I20100406000003 |
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