Provider Demographics
NPI:1558381954
Name:KAKOSSIAN, IRENE (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:KAKOSSIAN
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 1:8008 NARROWS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2831
Mailing Address - Country:US
Mailing Address - Phone:718-833-8777
Mailing Address - Fax:718-646-8400
Practice Address - Street 1:1180 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5801
Practice Address - Country:US
Practice Address - Phone:718-833-8777
Practice Address - Fax:718-646-8400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217115207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02064157Medicaid
NY02064157Medicaid
NY65Z501Medicare PIN