Provider Demographics
NPI:1265673115
Name:KAKOSSIAN MEDICAL WOMAN CARE PC
Entity Type:Organization
Organization Name:KAKOSSIAN MEDICAL WOMAN CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-833-8777
Mailing Address - Street 1:8008 NARROWS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2831
Mailing Address - Country:US
Mailing Address - Phone:718-833-8777
Mailing Address - Fax:
Practice Address - Street 1:1180 BRIGHTON BEACH AVE
Practice Address - Street 2:1ST.FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5801
Practice Address - Country:US
Practice Address - Phone:718-833-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217115207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty