Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 232682 | NY |
NPI | 1093768681 |
---|---|
Provider Name | Ms. Irina Koukharenko |
First Address | Brooklyn, NY 11235-7078 |
Second Address | Brooklyn, NY 11209-1550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02634619 | (05) | NY |
I20755 | (02) | NY |