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General NPI Number Information
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NPI Number | 1437321460
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Entity Type | Individual
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Provider Name | IRINA KORNEEVA-VLADIMIRSKY M.D.,PHD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 3065 BRIGHTON 7TH ST 2 ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11235-6414
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Country | US
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Telephone | 718-576-2012
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Fax | 718-576-1627
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Provider Business Mailing Address
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Address Line | 3065 BRIGHTON 7TH ST 2 ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11235-6414
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Country | US
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Telephone | 718-576-2012
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Fax | 718-576-1627
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA08391600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 249981
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License Number State | NY
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