Provider Demographics
NPI:1407813355
Name:KHEYFETS, IRINA A
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:A
Last Name:KHEYFETS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1441
Mailing Address - Country:US
Mailing Address - Phone:973-428-5430
Mailing Address - Fax:
Practice Address - Street 1:21 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1723
Practice Address - Country:US
Practice Address - Phone:973-754-4200
Practice Address - Fax:973-754-4201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06037900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG19993Medicare UPIN