Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 209962 | NY |
NPI | 1023023777 |
---|---|
Provider Name | Irina Pankova |
First Address | Brooklyn, NY 11235-6686 |
Second Address | Brooklyn, NY 11223-1780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H48921 | (02) | NY |