Provider Demographics
NPI:1023023777
Name:PANKOVA, IRINA (DO)
Entity type:Individual
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First Name:IRINA
Middle Name:
Last Name:PANKOVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:65 OCEANA DR E
Mailing Address - Street 2:APT 5D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6686
Mailing Address - Country:US
Mailing Address - Phone:718-872-7809
Mailing Address - Fax:
Practice Address - Street 1:445 KINGS HWY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1780
Practice Address - Country:US
Practice Address - Phone:718-645-2201
Practice Address - Fax:718-645-2207
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY209962207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH48921Medicare UPIN