Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 266852 | NY |
NPI | 1013114040 |
---|---|
Provider Name | Dr. Irina V Koreen |
First Address | Goshen, NY 10924-6752 |
Second Address | Goshen, NY 10924-6752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 08/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5914626 | (05) | NC |