Provider Demographics
NPI:1689003212
Name:HAMMER, IRINA KRUTOY (PA-C)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:KRUTOY
Last Name:HAMMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:KRUTOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8419 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3303
Mailing Address - Country:US
Mailing Address - Phone:718-259-0199
Mailing Address - Fax:718-256-0109
Practice Address - Street 1:760 BROADWAY # 10B101
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017143-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant