Provider Demographics
NPI:1871082933
Name:KOBLIUK, VIKTORIIA
Entity type:Individual
Prefix:
First Name:VIKTORIIA
Middle Name:
Last Name:KOBLIUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-2704
Mailing Address - Country:US
Mailing Address - Phone:917-704-7041
Mailing Address - Fax:
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922
Practice Address - Country:US
Practice Address - Phone:908-277-8679
Practice Address - Fax:908-277-8909
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00818800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner