Provider Demographics
NPI:1215958301
Name:MUNI, IRINA (MD)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:MUNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:BULAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:580 COTTAGE GROVE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3088
Mailing Address - Country:US
Mailing Address - Phone:860-243-8709
Mailing Address - Fax:860-243-8259
Practice Address - Street 1:580 COTTAGE GROVE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3088
Practice Address - Country:US
Practice Address - Phone:860-243-8709
Practice Address - Fax:860-243-8259
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010037506CT01OtherANTHEM BLUE SHIELD
0V7701OtherHEALTHNET
CT001375064Medicaid
CT110007659Medicare ID - Type Unspecified
CT010037506CT01OtherANTHEM BLUE SHIELD