Provider Demographics
NPI:1265846034
Name:STAICU, IRINA (DO, MMS)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:STAICU
Suffix:
Gender:F
Credentials:DO, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CHESTNUT ST UNIT 212
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1836
Mailing Address - Country:US
Mailing Address - Phone:856-580-3368
Mailing Address - Fax:
Practice Address - Street 1:1420 WALNUT ST STE 904
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:215-735-8052
Practice Address - Fax:215-735-5323
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018048207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation