Provider Demographics
NPI:1922423771
Name:IRINA KOVALEVA MEDICAL CARE PC
Entity Type:Organization
Organization Name:IRINA KOVALEVA MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVALEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-333-1025
Mailing Address - Street 1:2952 BRIGHTON 3RD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6897
Mailing Address - Country:US
Mailing Address - Phone:718-708-4046
Mailing Address - Fax:718-732-2728
Practice Address - Street 1:2952 BRIGHTON 3RD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6897
Practice Address - Country:US
Practice Address - Phone:718-708-4046
Practice Address - Fax:718-732-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223507208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02349948Medicaid
NY03836308Medicaid
NY02349948Medicaid
A100117167Medicare PIN