Provider Demographics
NPI:1598027187
Name:PITSEL, IRINA I
Entity Type:Individual
Prefix:MS
First Name:IRINA
Middle Name:
Last Name:PITSEL
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625E14 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-769-2698
Mailing Address - Fax:718-769-2317
Practice Address - Street 1:153 BATH AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1429
Practice Address - Country:US
Practice Address - Phone:646-932-1443
Practice Address - Fax:718-701-5234
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist