| Organization Name: | DR.IRINA MEDICAL P.C. |
| NPI Number: | 1609008119 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IRINA KOUKHARENKO (OWNER) |
| Mailing Address: | 11201 Queens Blvd Apt 24b Forest Hills |
| State: | NY US |
| Postal Code: | 113755594 |
| Phone Number: | 9175790382 |
| Fax Number: | 7183602279 |
| NPI Enumeration Date: | 08/17/2009 |
| NPI Last Update Date: | 11/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 232682 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |