Provider Demographics
NPI:1205873650
Name:PARTIGUL, IRENE
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:PARTIGUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 SEDGWICK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4422
Mailing Address - Country:US
Mailing Address - Phone:718-548-1212
Mailing Address - Fax:718-548-1900
Practice Address - Street 1:100 CLINTON ST
Practice Address - Street 2:LL2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4227
Practice Address - Country:US
Practice Address - Phone:718-254-0101
Practice Address - Fax:718-254-0182
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQQ5961Medicare ID - Type Unspecified