Provider Demographics
NPI:1134377054
Name:SHUMSKAYA, IRINA M (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:M
Last Name:SHUMSKAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PICARON PL
Mailing Address - Street 2:
Mailing Address - City:LAURENCE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2902
Mailing Address - Country:US
Mailing Address - Phone:732-970-3395
Mailing Address - Fax:
Practice Address - Street 1:5 PICARON PL
Practice Address - Street 2:
Practice Address - City:LAURENCE HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08879-2902
Practice Address - Country:US
Practice Address - Phone:732-970-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA043697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31713Medicare PIN