Healthcare Provider Details

I. General information

NPI: 1790077956
Provider Name (Legal Business Name): IRYNA DRYHYBKO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 AVENUE P
BROOKLYN NY
11229-1009
US

IV. Provider business mailing address

1668 W 6TH ST APT. 4D
BROOKLYN NY
11223-1357
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-1004
  • Fax: 718-376-1150
Mailing address:
  • Phone: 718-627-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number624758
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: