Healthcare Provider Details

I. General information

NPI: 1467819540
Provider Name (Legal Business Name): ROMAN ISAAC MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 ADAMS ST STE D-E
HOBOKEN NJ
07030-2370
US

IV. Provider business mailing address

1320 ADAMS ST STE D-E
HOBOKEN NJ
07030-2370
US

V. Phone/Fax

Practice location:
  • Phone: 201-308-6622
  • Fax: 201-308-6623
Mailing address:
  • Phone: 201-308-6622
  • Fax: 201-308-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number275010
License Number StateNY

VIII. Authorized Official

Name: DR. ROMAN ISAAC
Title or Position: CEO
Credential: MD
Phone: 201-308-6622