Healthcare Provider Details

I. General information

NPI: 1386783132
Provider Name (Legal Business Name): IRINE CORST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 BAY PKWY
BROOKLYN NY
11214
US

IV. Provider business mailing address

950 70TH ST APT.3A
BROOKLYN NY
11228-1100
US

V. Phone/Fax

Practice location:
  • Phone: 718-621-1800
  • Fax: 718-621-1365
Mailing address:
  • Phone: 718-621-1800
  • Fax: 718-621-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number214541
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number214541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: