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General NPI Number Information
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NPI Number | 1902248362
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Entity Type | Organization
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Legal Business Name | I MIKHEYEVA MEDICAL PC
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 111 NORTH 7TH ST.
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City | BROOKLYN
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State | NY
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Zip | 11211
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Country | US
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Telephone | 718-384-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 CROPSEY AVE 1D
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City | BROOKLYN
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State | NY
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Zip | 11214-6800
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Country | US
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Telephone | 718-986-6664
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. IRINA MIKHEYEVA
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Credential | DO
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Telephone | 718-986-6664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 254486
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License Number State | NY
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