Healthcare Provider Details

I. General information

NPI: 1699075358
Provider Name (Legal Business Name): MRS. VIRGINIA J ISAKSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RIVER AVE SUITE 245
LAKEWOOD NJ
08701-4738
US

IV. Provider business mailing address

102 WILSON AVE
PORT MONMOUTH NJ
07758-1546
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-1888
  • Fax: 732-367-5910
Mailing address:
  • Phone: 732-495-4137
  • Fax: 732-495-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: