Provider Demographics
NPI:1104311323
Name:IRIZARRY, ERICKA (MD)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:IRIZARRY
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 1:3332 WALDEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-2400
Mailing Address - Country:US
Mailing Address - Phone:716-880-3814
Mailing Address - Fax:716-817-2602
Practice Address - Street 1:3332 WALDEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-2400
Practice Address - Country:US
Practice Address - Phone:716-880-3814
Practice Address - Fax:716-817-2602
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator