Provider Demographics
NPI:1689475527
Name:IRIZARRY, ELIJAH ANTHONY
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:ANTHONY
Last Name:IRIZARRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 SYKESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08515-2411
Mailing Address - Country:US
Mailing Address - Phone:347-818-9854
Mailing Address - Fax:
Practice Address - Street 1:82 SYKESVILLE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08515-2411
Practice Address - Country:US
Practice Address - Phone:347-818-9854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01528300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist