Provider Demographics
NPI:1770736688
Name:POWERS, IRINA TIMOFEYEVNA (MD)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:TIMOFEYEVNA
Last Name:POWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:227 MADISON ST
Mailing Address - Street 2:MEDICAL STAFF
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7537
Mailing Address - Country:US
Mailing Address - Phone:212-238-7614
Mailing Address - Fax:212-238-7009
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:MEDICAL STAFF
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7614
Practice Address - Fax:212-238-7009
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2015-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY240610207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY240610OtherNYS LICENSE NUMBER