Provider Demographics
NPI:1083667315
Name:SHUR, IRINA N (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:N
Last Name:SHUR
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 1:26 SHEPHERDS DR
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7017
Mailing Address - Country:US
Mailing Address - Phone:718-708-7525
Mailing Address - Fax:718-708-7526
Practice Address - Street 1:140 ELGAR PLACE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5207
Practice Address - Country:US
Practice Address - Phone:718-708-7525
Practice Address - Fax:718-708-7525
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH33229Medicare UPIN
002AF1Medicare PIN