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General NPI Number Information
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NPI Number | 1578977047
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Entity Type | Individual
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Provider Name | IRINA CHIKVASHVILI D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 12/13/2018
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Provider Practice Location Address
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Address Line | 230 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1121
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Country | US
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Telephone | 215-831-4819
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Fax |
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Provider Business Mailing Address
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Address Line | 75-59 263RD STREET, ACP BUILDING
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City | GLEN OAKS
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State | NY
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Zip | 11004
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Country | US
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Telephone |
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 287965
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License Number State | NY
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