Individual provider Active NPI

Irina Mikolaenko, MD

  • Neuropathology Physician
  • New York, NY
National Provider Identifier
1245296607
Registry record updated Sep 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuropathology PhysicianTaxonomy code 207ZN0500X
License
248672 Issued in NY
Practice address
560 1St Ave
New York, NY 10016-6402
Phone
(212) 263-2269
Fax
(212) 263-7916
NPI assigned
Apr 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 40998 TN
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 35088734 OH
Neuropathology Physician 207ZN0500X 248672 NY Primary

Addresses

Primary practice location

560 1St Ave
New York, NY 10016-6402

Mailing address

3131 Princeton Pike
BLDG 5 Suite 208
Lawrenceville, NJ 08648
Phone (609) 815-7829

Other identifiers 8

IdentifierTypeStateIssuer
2691298MedicaidOH
000000224455OtherOHUNISON
000000528774OtherOHANTHEM
363842OtherOHWELLCARE
744994OtherOHBUCKEYE
P00426302OtherOHRAILROAD MEDICARE
0127464OtherOHBCMH
7301634OtherOHAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160519000787 NJ Practitioner - Pathology 9032149059 Reassigns benefits to 1 organization
I20171102001223 PA Practitioner - Pathology 9032149059 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Health Medical GroupGroup PAC ID 7618264532, 442 clinicians

Practice addresses (Care Compare)

1 Capital Way
Pennington, NJ 08534-2520
Phone (609) 303-4244

Hospital & facility affiliations

  • Capital Health Regional Medical Center Hospital, Trenton, NJ, CCN 310092

Merit-based Incentive Payment System (MIPS)

Final score
96.91 of 100Reported as apm
Quality
79.42
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35088734OHMDAnatomic Pathology & Clinical Pathology Physician
40998TNMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
STC Pediatrics LLC CurrentSince Dec 1, 2019 Accepting new patients
STC Pediatrics LLC CurrentSince Dec 1, 2019 Accepting new patients
Capital Health Medical Group CurrentSince Sep 13, 2016 Accepting new patients
STC Pediatrics LLC Current Accepting new patients
New York University Medical Center Pathology Associates Neuropathology PastSince Aug 1, 1991 Accepting new patients
MCV Associated Physicians Anatomic Pathology & Clinical Pathology PastSince Sep 28, 2021 Accepting new patients

Locations

3131 Princeton Pike
Bldg 5
Lawrenceville, NJ 08648
Phone (609) 844-9661

1 Capital Way
Pennington, NJ 08534
Phone (609) 303-4000

750 Brunswick Ave
Trenton, NJ 08638
Phone (609) 394-6000

153 Brodhead Rd
Bethlehem, PA 18017
Phone (484) 526-3200

160 E Erie Ave
Philadelphia, PA 19134
Phone (215) 427-4067

300 E Hunting Park Ave
Philadelphia, PA 19124
Phone (215) 427-8363

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12833/brand/1/csg/1/fhir/r4

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475107200000",
    "number": "1245296607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 PRINCETON PIKE",
            "address_2": "BLDG 5 SUITE 208",
            "city": "LAWRENCEVILLE",
            "state": "NJ",
            "postal_code": "08648",
            "telephone_number": "609-815-7829",
            "fax_number": "609-815-7894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402",
            "telephone_number": "212-263-2269",
            "fax_number": "212-263-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKOLAENKO",
        "first_name": "IRINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2016-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TN",
            "license": "40998",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OH",
            "license": "35088734",
            "primary": false
        },
        {
            "code": "207ZN0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Neuropathology",
            "state": "NY",
            "license": "248672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2691298",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000224455",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000528774",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "363842",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE",
            "identifier": "744994",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00426302",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCMH",
            "identifier": "0127464",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7301634",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.