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NPI Code Detail

MEDICARE: IRINA KARAVANCHENKO DPT

MEDICARE: IRINA KARAVANCHENKO DPT
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
1283X00000XRehabilitation Hospital

General Provider Information

NPI Number : 1467668954
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRINA KARAVANCHENKO DPT
Provider Business Mailing Address
First Line : 564 GREELEY AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-5808
Country : US
Telephone Number : 718-283-8961
Fax Number :
Provider Business Practice Location Address
First Line : 883 65TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11220-4737
Country : US
Telephone Number : 718-283-8960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/08/2007

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Directions to “ IRINA KARAVANCHENKO DPT” Practice Location

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