Provider Demographics
NPI:1245296607
Name:MIKOLAENKO, IRINA (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:MIKOLAENKO
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 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG 5 SUITE 208
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-815-7829
Mailing Address - Fax:609-815-7894
Practice Address - Street 1:560 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-2269
Practice Address - Fax:212-263-7916
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40998207ZP0102X
OH35088734207ZP0102X
NY248672207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2691298Medicaid
OH000000224455OtherUNISON
OH000000528774OtherANTHEM
OH363842OtherWELLCARE
OH744994OtherBUCKEYE
OHP00426302OtherRAILROAD MEDICARE
OH0127464OtherBCMH
OH7301634OtherAETNA
OH7301634OtherAETNA
OH2691298Medicaid
OHMI4194892Medicare PIN