MEDICARE: IRINA VOLYNSKY PHD

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	103T00000X	Psychologist	68 017595	NY

General Provider Information

NPI Number	:	1184862997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA VOLYNSKY PHD

Provider Business Mailing Address
First Line	:	440 WEST ST
Second Line	:	SUITE 23
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5028
Country	:	US
Telephone Number	:	917-657-8925
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 WEST ST
Second Line	:	SUITE 23
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5028
Country	:	US
Telephone Number	:	917-657-8925
Fax Number	:

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

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	12/18/2009

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