Healthcare Provider Details

I. General information

NPI: 1407813355
Provider Name (Legal Business Name): DR. IRINA A KHEYFETS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MARKET ST
PATERSON NJ
07501-1723
US

IV. Provider business mailing address

365 RIDGEDALE AVE
EAST HANOVER NJ
07936-1441
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-4200
  • Fax: 973-754-4201
Mailing address:
  • Phone: 973-428-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06037900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: