MEDICARE: IRINA PYATETSKY

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		NY
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1659632727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA PYATETSKY

Provider Business Mailing Address
First Line	:	2780 W 5TH ST APT 23G
Second Line	:	23G
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4152
Country	:	US
Telephone Number	:	347-576-9406
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 W 127TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-3723
Country	:	US
Telephone Number	:	212-752-7575
Fax Number	:	212-752-7564

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/01/2016

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Directions to “ IRINA PYATETSKY ” Practice Location

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