Provider Demographics
NPI:1366687832
Name:NAZAROVA, IRINA (MS)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:NAZAROVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 DOUGLAS AVE APT 10G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3547
Mailing Address - Country:US
Mailing Address - Phone:171-860-1556
Mailing Address - Fax:
Practice Address - Street 1:4465 DOUGLAS AVE APT 10G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3547
Practice Address - Country:US
Practice Address - Phone:171-860-1556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist