Provider Demographics
NPI:1962494732
Name:IRIZA, ECATERINA (MD)
Entity Type:Individual
Prefix:
First Name:ECATERINA
Middle Name:
Last Name:IRIZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:175 S WILKES BARRE BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5040
Practice Address - Country:US
Practice Address - Phone:570-829-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129688208000000X
NY215035208000000X
PAMD068933L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02098680Medicaid
PA0017546950006Medicaid
NY215035OtherSTATE LICENSE
FLME129688OtherFLORIDA MEDICAL LICENSE
FLME129688OtherFLORIDA MEDICAL LICENSE
FLME129688OtherFLORIDA MEDICAL LICENSE
NY215035OtherSTATE LICENSE