Healthcare Provider Details

I. General information

NPI: 1275582694
Provider Name (Legal Business Name): IRINA ARTUROVNA KAZACHKOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 48TH ST
BROOKLYN NY
11219-2918
US

IV. Provider business mailing address

977 48TH ST ATTENTION: KATHLYN ORLANDO
BROOKLYN NY
11219-2919
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8260
  • Fax: 718-283-6147
Mailing address:
  • Phone: 718-283-8015
  • Fax: 718-635-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number230684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: