MEDICARE: DR. IRINA KIBLITSKY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	246958	NY

General Provider Information

NPI Number	:	1215112719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRINA KIBLITSKY M.D.

Provider Business Mailing Address
First Line	:	1329 E 17TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6052
Country	:	US
Telephone Number	:	718-382-5060
Fax Number	:	718-382-5905

Provider Business Practice Location Address
First Line	:	1329 E 17TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6052
Country	:	US
Telephone Number	:	718-382-5060
Fax Number	:	718-382-5905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	09/17/2021

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