Healthcare Provider Details

I. General information

NPI: 1699856021
Provider Name (Legal Business Name): IRINA KATKOVSKAYA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - DEPT. OF OPHTHALMOLOGY 3400 BAINBRIDGE AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

2300 OLINVILLE AVE APT. 17F
BRONX NY
10467-7817
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2020
  • Fax:
Mailing address:
  • Phone: 718-920-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number006937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: