Healthcare Provider Details

I. General information

NPI: 1922326891
Provider Name (Legal Business Name): JULIE AMY IZSAK MED,RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE AMY SUSSMAN

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

IV. Provider business mailing address

PO BOX 3677
NASHUA NH
03061-3677
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-3275
  • Fax: 603-577-2432
Mailing address:
  • Phone: 603-577-7900
  • Fax: 603-577-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0570
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0636
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: