Provider Demographics
NPI:1003219635
Name:ISRAILOVA, IRENA (MS GEN AND SPEC ED)
Entity Type:Individual
Prefix:MS
First Name:IRENA
Middle Name:
Last Name:ISRAILOVA
Suffix:
Gender:F
Credentials:MS GEN AND SPEC ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 GRAND CENTRAL PKWY
Mailing Address - Street 2:B1102
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1263
Mailing Address - Country:US
Mailing Address - Phone:646-420-7735
Mailing Address - Fax:
Practice Address - Street 1:6120 GRAND CENTRAL PKWY
Practice Address - Street 2:B1102
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1263
Practice Address - Country:US
Practice Address - Phone:646-420-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3568882390200000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program