Provider Demographics
NPI:1073740460
Name:VERGILIS-KALNER, IRENE JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:JOSEPHINE
Last Name:VERGILIS-KALNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SEACOAST TER APT 18M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6008
Mailing Address - Country:US
Mailing Address - Phone:917-531-6041
Mailing Address - Fax:
Practice Address - Street 1:2727 OCEAN PKWY STE L1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7848
Practice Address - Country:US
Practice Address - Phone:718-975-7546
Practice Address - Fax:718-975-7547
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256563207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY256563OtherLICENSE
NJ0255076Medicaid