Provider Demographics
NPI:1619925344
Name:NATALENKO, IRINA (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:NATALENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOLIDAY CT
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2931
Mailing Address - Country:US
Mailing Address - Phone:516-791-4748
Mailing Address - Fax:718-337-1548
Practice Address - Street 1:407 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3647
Practice Address - Country:US
Practice Address - Phone:718-471-7010
Practice Address - Fax:718-337-1548
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2215731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02200282Medicaid
NYH49270Medicare UPIN
NY09388MMedicare ID - Type Unspecified