MEDICARE: DR. IRINA N SHUR 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	174400000X	Specialist	214511	NY

General Provider Information

NPI Number	:	1083667315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRINA N SHUR MD

Provider Business Mailing Address
First Line	:	26 SHEPHERDS DR
Second Line	:
City	:	SCARSDALE
State	:	NY
Zip	:	10583-7017
Country	:	US
Telephone Number	:	718-708-7525
Fax Number	:	718-708-7526

Provider Business Practice Location Address
First Line	:	140 ELGAR PLACE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-5207
Country	:	US
Telephone Number	:	718-708-7525
Fax Number	:	718-708-7525

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/31/2008

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