Provider Demographics
NPI:1366817652
Name:GOLDSON, VICTORIA LEIGH (PT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEIGH
Last Name:GOLDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LEIGH
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2142 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4142
Mailing Address - Country:US
Mailing Address - Phone:718-819-6805
Mailing Address - Fax:347-841-9109
Practice Address - Street 1:66 COMMACK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3405
Practice Address - Country:US
Practice Address - Phone:631-486-5286
Practice Address - Fax:631-486-5287
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02116500225100000X
NY039678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WFH1Medicare PIN