Irina Medical P.C.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

232682 Issued in NY

Legal business name

IRINA MEDICAL P.C.

Practice address

474 Ovington Ave
Brooklyn, NY 11209-1550

Phone

(718) 238-2625

Fax

(718) 238-2704

NPI assigned

Aug 17, 2009

Last updated

Nov 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Irina Koukharenko, MDNPI 1093768681

Title

Owner

Phone

(718) 238-2625

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Irina Koukharenko, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Brooklyn, NY
  • NPI 1093768681
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1250467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1609008119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2952 BRIGHTON 3RD ST STE 201",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112357078",
            "telephone_number": "718-975-4334",
            "fax_number": "718-975-4337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 OVINGTON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112091550",
            "telephone_number": "718-238-2625",
            "fax_number": "718-238-2704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRINA MEDICAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-17",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "KOUKHARENKO",
        "authorized_official_first_name": "IRINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-238-2625",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "232682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02634619",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• General Practice Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.