Provider Demographics
NPI:1285754432
Name:LUDNER, IRINA (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:LUDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:KIMYAGAROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6395 AUSTIN ST
Mailing Address - Street 2:APT 3 H
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3051
Mailing Address - Country:US
Mailing Address - Phone:347-622-0441
Mailing Address - Fax:
Practice Address - Street 1:10933 71ST RD
Practice Address - Street 2:SUITE 1 B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4867
Practice Address - Country:US
Practice Address - Phone:718-520-8585
Practice Address - Fax:718-520-8688
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02931771Medicaid