MEDICARE: MRS. IRINA GIRSHOVICH MD

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	207R00000X	Internal Medicine Physician	MA62306	NJ

General Provider Information

NPI Number	:	1043287212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IRINA GIRSHOVICH MD

Provider Business Mailing Address
First Line	:	810 ABBOTT BLVD
Second Line	:	SUITE 201
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4151
Country	:	US
Telephone Number	:	201-886-9699
Fax Number	:	201-886-9015

Provider Business Practice Location Address
First Line	:	810 ABBOTT BLVD
Second Line	:	SUITE 201
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4151
Country	:	US
Telephone Number	:	201-886-9699
Fax Number	:	201-886-9015

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	04/01/2009

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