MEDICARE: IRINA SHUR INTERNAL MEDICINE P.C.

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	207Q00000X	Family Medicine Physician	214511	NY

General Provider Information

NPI Number	:	1316149776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRINA SHUR INTERNAL MEDICINE P.C.

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 PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-5201
Country	:	US
Telephone Number	:	718-708-7525
Fax Number	:	718-708-7526

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	IRINA SHUR
Credential	:	MD
Telephone Number	:	718-708-7525

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/31/2008

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