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General NPI Number Information
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NPI Number | 1912271354
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Entity Type | Individual
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Provider Name | IRINA CHAIKHOUTDINOVA PA
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Gender | Female
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 1513 VOORHIES AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-3913
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Country | US
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Telephone | 718-332-4440
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Fax | 718-332-0077
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Provider Business Mailing Address
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Address Line | 105 KINGS HWY APT 5C
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City | BROOKLYN
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State | NY
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Zip | 11214-1562
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Country | US
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Telephone | 917-907-3203
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 009805-1
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License Number State | NY
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