Provider Demographics
NPI:1396966578
Name:PAEK, IRENE (MD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:PAEK
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 1:1548 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1232
Mailing Address - Country:US
Mailing Address - Phone:917-583-0318
Mailing Address - Fax:
Practice Address - Street 1:30 NEWBRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2150
Practice Address - Country:US
Practice Address - Phone:516-731-5740
Practice Address - Fax:516-731-1140
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243404207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine