MEDICARE: DR. FRANK WILLIAM ISELE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	004220	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000490450001	OTHER	NY	BLUE SHIELD
2	V44411	OTHER	NY	BLUE CROSS

General Provider Information

NPI Number	:	1306925789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK WILLIAM ISELE PHD

Provider Business Mailing Address
First Line	:	478 GLEN STREET
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-2926
Country	:	US
Telephone Number	:	518-792-1410
Fax Number	:	518-792-0514

Provider Business Practice Location Address
First Line	:	478 GLEN STREET
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-2926
Country	:	US
Telephone Number	:	518-792-1410
Fax Number	:	518-792-0514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2006
Last Update Date	:	12/15/2010

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