Provider Demographics
NPI:1437321460
Name:KORNEEVA-VLADIMIRSKY, IRINA (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:KORNEEVA-VLADIMIRSKY
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 BRIGHTON 7TH ST
Mailing Address - Street 2:2 ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6414
Mailing Address - Country:US
Mailing Address - Phone:718-576-2012
Mailing Address - Fax:718-576-1627
Practice Address - Street 1:3065 BRIGHTON 7TH ST
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6414
Practice Address - Country:US
Practice Address - Phone:718-576-2012
Practice Address - Fax:718-576-1627
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08391600207Q00000X
NY249981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine