Healthcare Provider Details

I. General information

NPI: 1942887468
Provider Name (Legal Business Name): GREGORY KENNETH ISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 ROUTE 33,
NEPTUNE NJ
07753
US

IV. Provider business mailing address

331 NEWMAN SPRINGS ROAD BLDG. 2, SUITE 220
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-2342
  • Fax: 732-776-2344
Mailing address:
  • Phone: 732-807-0877
  • Fax: 201-751-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA12173000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: