Provider Demographics
NPI:1699124099
Name:WITEK, IRYNE
Entity type:Individual
Prefix:
First Name:IRYNE
Middle Name:
Last Name:WITEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MESEROLE ST
Mailing Address - Street 2:#31
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2152
Mailing Address - Country:US
Mailing Address - Phone:718-724-4800
Mailing Address - Fax:
Practice Address - Street 1:165 MESEROLE ST
Practice Address - Street 2:#31
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2152
Practice Address - Country:US
Practice Address - Phone:718-724-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY568251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse