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General NPI Number Information
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NPI Number | 1740367630
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Entity Type | Individual
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Provider Name | IRINA KOROBOV MD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 1130 BRIGHTON BEACH AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-5555
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Country | US
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Telephone | 718-918-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 100 DEMAREST AVE
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City | CLOSTER
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State | NJ
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Zip | 07624-1738
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Country | US
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Telephone | 201-660-7540
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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 | 169944
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License Number State | NY
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