Provider Demographics
NPI:1386783132
Name:CORST, IRINE (MD)
Entity type:Individual
Prefix:
First Name:IRINE
Middle Name:
Last Name:CORST
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 1:950 70TH ST
Mailing Address - Street 2:APT.3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1100
Mailing Address - Country:US
Mailing Address - Phone:718-621-1800
Mailing Address - Fax:718-621-1365
Practice Address - Street 1:8405 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214
Practice Address - Country:US
Practice Address - Phone:718-621-1800
Practice Address - Fax:718-621-1365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214541207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH46597Medicare UPIN
NY8I973YRTP1Medicare PIN
NY8I9731Medicare ID - Type Unspecified
NY8I973DW092Medicare PIN