Provider Demographics
NPI:1891354932
Name:IRINA STAICU DO LLC
Entity Type:Organization
Organization Name:IRINA STAICU DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAICU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-735-8052
Mailing Address - Street 1:328 COBBLE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1839
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:19102-4009
Practice Address - Country:US
Practice Address - Phone:215-735-8052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265846034OtherNPI
PAOS018048OtherPA STATE LICENSE
PAOS018048OtherPA STATE LICENSE