Provider Demographics
NPI:1275582694
Name:KAZACHKOVA, IRINA ARTUROVNA (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:ARTUROVNA
Last Name:KAZACHKOVA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:977 48TH ST
Mailing Address - Street 2:ATTENTION: KATHLYN ORLANDO
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2919
Mailing Address - Country:US
Mailing Address - Phone:718-283-8015
Mailing Address - Fax:718-635-7235
Practice Address - Street 1:948 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2918
Practice Address - Country:US
Practice Address - Phone:718-283-8260
Practice Address - Fax:718-283-6147
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2306842080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11576603OtherCAQH ID#