Provider Demographics
NPI:1194740506
Name:AVRUCHEVSKAYA, IRINA (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:AVRUCHEVSKAYA
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 1:593 JUNE PLACE
Mailing Address - Street 2:
Mailing Address - City:NORTH WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:516-812-3938
Mailing Address - Fax:
Practice Address - Street 1:1220 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-376-1004
Practice Address - Fax:718-376-1150
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01710223Medicaid
NY17N221Medicare ID - Type Unspecified
NYG38666Medicare UPIN