Healthcare Provider Details

I. General information

NPI: 1154765998
Provider Name (Legal Business Name): REESE PRESCOTT ISAACSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST
WATERBURY CT
06708-2613
US

IV. Provider business mailing address

1200 N STATE ST CT-A7D
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6232
  • Fax: 203-573-6030
Mailing address:
  • Phone: 323-226-7556
  • Fax: 323-226-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number56916
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: