Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 230684 | NY |
NPI | 1275582694 |
---|---|
Provider Name | Irina Arturovna Kazachkova |
First Address | Brooklyn, NY 11219-2919 |
Second Address | Brooklyn, NY 11219-2918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 24/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11576603 | CAQH ID# (01) | NY |