MEDICARE: IRINA PANKOVA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	209962	NY

General Provider Information

NPI Number	:	1023023777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA PANKOVA DO

Provider Business Mailing Address
First Line	:	65 OCEANA DR E
Second Line	:	APT 5D
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6686
Country	:	US
Telephone Number	:	718-872-7809
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 KINGS HWY
Second Line	:	1ST FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1780
Country	:	US
Telephone Number	:	718-645-2201
Fax Number	:	718-645-2207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/08/2007

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