Provider Demographics
NPI:1568898872
Name:FABRE, IRINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:FABRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743-749 EAST 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-5335
Mailing Address - Country:US
Mailing Address - Phone:212-677-9999
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3376
Practice Address - Country:US
Practice Address - Phone:215-746-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014603363LA2200X
NY306658363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331943Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY00695941Medicaid
NY331944Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331952Medicare Oscar/Certification