Provider Demographics
NPI:1831491364
Name:BREYTUS, IRINA (MS SLP)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:BREYTUS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 OVINGTON AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1511
Mailing Address - Country:US
Mailing Address - Phone:646-400-3860
Mailing Address - Fax:
Practice Address - Street 1:1538 E 35TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3439
Practice Address - Country:US
Practice Address - Phone:718-614-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist