Provider Demographics
NPI:1639129026
Name:PLESKOVA, IRENA (MD)
Entity type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:PLESKOVA
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 1:3364 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4004
Mailing Address - Country:US
Mailing Address - Phone:347-570-5348
Mailing Address - Fax:347-305-9539
Practice Address - Street 1:3364 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4004
Practice Address - Country:US
Practice Address - Phone:347-570-5348
Practice Address - Fax:347-305-9539
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203695207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01707175Medicaid
NY01707175Medicaid
NY04342UMedicare PIN
04342UMedicare ID - Type UnspecifiedGHI MEDICARE