Healthcare Provider Details

I. General information

NPI: 1801922489
Provider Name (Legal Business Name): JOHN D IZSAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17629 CHARNWOOD DR
BOCA RATON FL
33498-6427
US

IV. Provider business mailing address

17629 CHARNWOOD DR
BOCA RATON FL
33498-6427
US

V. Phone/Fax

Practice location:
  • Phone: 413-567-8792
  • Fax:
Mailing address:
  • Phone: 413-567-8792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30934
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: