Provider Demographics
NPI:1821112079
Name:MARCOFF, IRINA (DPT)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:MARCOFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:TATARKINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:571 CENTRAL AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1547
Mailing Address - Country:US
Mailing Address - Phone:908-790-9000
Mailing Address - Fax:718-760-1178
Practice Address - Street 1:571 CENTRAL AVE STE 106
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:908-790-9000
Practice Address - Fax:718-760-1178
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027042-1174400000X
NY40QA01647900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist