Provider Demographics
NPI:1508807603
Name:VEKSLER-OFFENGENDEN, IRENA (MD)
Entity Type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:VEKSLER-OFFENGENDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WALLS DR
Mailing Address - Street 2:STE. 405
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5163
Mailing Address - Country:US
Mailing Address - Phone:203-259-7070
Mailing Address - Fax:203-254-7402
Practice Address - Street 1:55 WALLS DR
Practice Address - Street 2:STE. 405
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5163
Practice Address - Country:US
Practice Address - Phone:203-259-7070
Practice Address - Fax:203-254-7402
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043202207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I40249Medicare UPIN
CT030000136Medicare ID - Type Unspecified