Provider Demographics
NPI:1316910599
Name:VICTORY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:VICTORY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PATIIENT ACCOUNTS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-567-1006
Mailing Address - Street 1:699 92ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3619
Mailing Address - Country:US
Mailing Address - Phone:718-597-1234
Mailing Address - Fax:718-567-2576
Practice Address - Street 1:699 92ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3619
Practice Address - Country:US
Practice Address - Phone:718-597-1234
Practice Address - Fax:718-567-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001032H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY64EMedicaid
NY00243449Medicaid
NY01196318Medicaid
NY451Medicaid
NY64EMedicaid
NY330242Medicare Oscar/Certification
NY01196318Medicaid