Provider Demographics
NPI:1598067142
Name:IRINA BULMASH OT PC
Entity Type:Organization
Organization Name:IRINA BULMASH OT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULMASH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:347-537-7171
Mailing Address - Street 1:1917 STATE HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13733-3228
Mailing Address - Country:US
Mailing Address - Phone:134-753-7717
Mailing Address - Fax:
Practice Address - Street 1:58 OLIVER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6502
Practice Address - Country:US
Practice Address - Phone:347-537-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012758252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency