Provider Demographics
NPI:1467668954
Name:KARAVANCHENKO, IRINA (DPT)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KARAVANCHENKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5808
Mailing Address - Country:US
Mailing Address - Phone:718-283-8961
Mailing Address - Fax:
Practice Address - Street 1:883 65TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4737
Practice Address - Country:US
Practice Address - Phone:718-283-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital