Healthcare Provider Details

I. General information

NPI: 1316020035
Provider Name (Legal Business Name): IRINA V. EFREMOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 HOES LN UNIVERSITY BEHAVIORAL HEALTHCARE CENTER
PISCATAWAY NJ
08854-5627
US

IV. Provider business mailing address

317 GEORGE ST 3RD FLOOR, PROVIDER ENROLLMENT
NEW BRUNSWICK NJ
08901-2008
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-4402
  • Fax: 732-235-3923
Mailing address:
  • Phone: 732-235-6772
  • Fax: 732-235-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number25MA068611
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: