Provider Demographics
NPI:1801881164
Name:LYTRIVI, IRENE (MD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:LYTRIVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L.LEVY PLACE
Mailing Address - Street 2:BOX #1201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-8662
Mailing Address - Fax:646-537-9228
Practice Address - Street 1:1 GUSTAVE L.LEVY PLACE
Practice Address - Street 2:BOX #1201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-8662
Practice Address - Fax:646-537-9228
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0021332080P0202X, 208000000X
NY267287208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002133-A15OtherHEALTH FIRST
NY1000044583OtherAFFINITY HEALTH
NYP3302848OtherOXFORD HEALTH PLAN
NY113491197OtherPHCS
NY3176R1OtherEMPIRE BCBS
NY3610446OtherAETNA USHC HMO
NYLI2133OtherATLANTIS HEALTH
NY7296567OtherAETNA PPO
NY002133OtherHIP
NY11-3491197OtherHORIZON HEALTHCARE NY
NY193600101OtherHEALTH PLUS
NY02572287Medicaid
NY2439692 06OtherUNITED HEALTH CARE
NY0102205OtherAMERICHOICE
NY3C7841OtherHEALTH NET
NY113491197OtherMULTIPLAN
NY3176R1OtherEMPIRE BCBS
NY3C7841OtherHEALTH NET