Provider Demographics
NPI:1104356385
Name:VIKNER, LOUISA (MD)
Entity type:Individual
Prefix:
First Name:LOUISA
Middle Name:
Last Name:VIKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39-24 GARVEY PL
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5356
Mailing Address - Country:US
Mailing Address - Phone:201-312-7836
Mailing Address - Fax:
Practice Address - Street 1:1 W RIDGEWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2350
Practice Address - Country:US
Practice Address - Phone:201-689-9968
Practice Address - Fax:201-689-9978
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11147700207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program