Provider Demographics
NPI:1104064971
Name:STAAB, VICTORIYA (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIYA
Middle Name:
Last Name:STAAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTORIYA
Other - Middle Name:
Other - Last Name:CHERNYAVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19 DAVIS AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4488
Mailing Address - Country:US
Mailing Address - Phone:732-935-0407
Mailing Address - Fax:732-935-0757
Practice Address - Street 1:19 DAVIS AVE FL 4
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4488
Practice Address - Country:US
Practice Address - Phone:732-935-0407
Practice Address - Fax:732-935-0757
Is Sole Proprietor?:No
Enumeration Date:2009-01-31
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA088835002086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery