Provider Demographics
NPI:1316020035
Name:EFREMOVA, IRINA V (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:V
Last Name:EFREMOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:317 GEORGE ST
Mailing Address - Street 2:3RD FLOOR, PROVIDER ENROLLMENT
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2008
Mailing Address - Country:US
Mailing Address - Phone:732-235-6772
Mailing Address - Fax:732-235-8347
Practice Address - Street 1:675 HOES LN
Practice Address - Street 2:UNIVERSITY BEHAVIORAL HEALTHCARE CENTER
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5627
Practice Address - Country:US
Practice Address - Phone:732-235-4402
Practice Address - Fax:732-235-3923
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA0686112084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8051402Medicaid
032514Medicare ID - Type Unspecified
H05704Medicare UPIN