Healthcare Provider Details

I. General information

NPI: 1962494732
Provider Name (Legal Business Name): ECATERINA IRIZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/07/2023
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S WILKES BARRE BLVD
WILKES BARRE PA
18702-5040
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-829-2621
  • Fax:
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME129688
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number215035
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD068933L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02098680
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier0017546950006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier215035
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerSTATE LICENSE
# 4
IdentifierME129688
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerFLORIDA MEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: