Healthcare Provider Details

I. General information

NPI: 1598866550
Provider Name (Legal Business Name): IRINA TKACH-CHUBAY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BURLINGTON MOUNT HOLLY RD
BURLINGTON NJ
08016-4722
US

IV. Provider business mailing address

1 FEDERAL ST STE 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 609-835-5570
  • Fax:
Mailing address:
  • Phone: 856-356-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MAO7839000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: