Provider Demographics
NPI:1942202437
Name:LELCHUK, IRINA (MD, D,O)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:LELCHUK
Suffix:
Gender:F
Credentials:MD, D,O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 E 22ND ST
Mailing Address - Street 2:APT 1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3602
Mailing Address - Country:US
Mailing Address - Phone:718-648-4545
Mailing Address - Fax:718-648-7788
Practice Address - Street 1:2195 E 22ND ST
Practice Address - Street 2:APT 1C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3602
Practice Address - Country:US
Practice Address - Phone:718-648-4545
Practice Address - Fax:718-648-7788
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA216744207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02141688Medicaid
NY556L41Medicare ID - Type Unspecified
NY02141688Medicaid