MEDICARE: I A IRISAS LLC

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

General Provider Information

NPI Number	:	1629937974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I A IRISAS LLC

Provider Business Mailing Address
First Line	:	141 HAVEN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-5240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 HAVEN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-5240
Country	:	US
Telephone Number	:	718-300-5831
Fax Number	:

Authorized Official
Title or Position	:	SPECIAL EDUCATION PROVIDER
Name	:	MRS. IRISA AGALLIU
Credential	:
Telephone Number	:	718-300-5831

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “I A IRISAS LLC ” Practice Location

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