Basic Information
| Provider Information | |||||||||
| NPI: | 1962494732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IRIZA | ||||||||
| FirstName: | ECATERINA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | 5702716578 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 S WILKES BARRE BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187025040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708292621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME129688 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 215035 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD068933L | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 02098680 | 05 | NY | MEDICAID | 0017546950006 | 05 | PA | MEDICAID | BI6646927 | 01 | NY | DEA | OTHER | 215035 | 01 | NY | STATE LICENSE | OTHER | ME129688 | 01 | FL | FLORIDA MEDICAL LICENSE | OTHER |