Healthcare Provider Details

I. General information

NPI: 1942382718
Provider Name (Legal Business Name): IRINA INNA KAPLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 SARATOGA AVE
WATERFORD NY
12188-2205
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-233-1162
  • Fax: 518-233-0903
Mailing address:
  • Phone: 518-525-5634
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number214690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: