Healthcare Provider Details

I. General information

NPI: 1245411354
Provider Name (Legal Business Name): IRINA MIKHEYEVA D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 OCEAN AVE STE 402
BROOKLYN NY
11229-1487
US

IV. Provider business mailing address

2701 CROPSEY AVE APT D1
BROOKLYN NY
11214-6800
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-7533
  • Fax: 718-975-7530
Mailing address:
  • Phone: 718-907-0195
  • Fax: 718-907-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number254486
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number254486
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: