Provider Demographics
NPI:1811869969
Name:KONDRATEVA, IRINA (FNP)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KONDRATEVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 COLBY CT APT 6F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6127
Mailing Address - Country:US
Mailing Address - Phone:347-722-3765
Mailing Address - Fax:
Practice Address - Street 1:2677 COLBY CT APT 6F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6127
Practice Address - Country:US
Practice Address - Phone:347-722-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353637-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty