Provider Demographics
NPI:1235176462
Name:ANSHELEVICH, IRINA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:ANSHELEVICH
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 1:277 FOREST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5410
Mailing Address - Country:US
Mailing Address - Phone:201-986-1881
Mailing Address - Fax:201-986-1871
Practice Address - Street 1:277 FOREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5410
Practice Address - Country:US
Practice Address - Phone:201-986-1881
Practice Address - Fax:201-986-1871
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07650700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI00078Medicare UPIN
091155ABFMedicare ID - Type Unspecified