Provider Demographics
NPI:1609008119
Name:IRINA MEDICAL P.C.
Entity Type:Organization
Organization Name:IRINA MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUKHARENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-238-2625
Mailing Address - Street 1:2952 BRIGHTON 3RD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7078
Mailing Address - Country:US
Mailing Address - Phone:718-975-4334
Mailing Address - Fax:718-975-4337
Practice Address - Street 1:474 OVINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1550
Practice Address - Country:US
Practice Address - Phone:718-238-2625
Practice Address - Fax:718-238-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232682208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02634619Medicaid
NY02634619Medicaid
NY07286Medicare PIN
NYA100017621Medicare PIN
NYA400017622Medicare PIN
NY244AN1Medicare PIN