Individual
DR. IRAIDA KAZACHKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
150 55TH ST, LMC PHYSICIAN SERVICES PC, BROOKLYN, NY 11220-2559
(718) 630-7000
(718) 630-8515
Mailing address
5800 3RD AVE, MANAGED CARE DEPARTMENT, BROOKLYN, NY 11220-3702
(718) 630-7477
(718) 630-7437
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
217594
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02128765
—
NY
Enumeration date
09/29/2006
Last updated
08/29/2022
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