Healthcare Provider Details

I. General information

NPI: 1881785343
Provider Name (Legal Business Name): ISAAC J DWECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MONMOUTH RD
OAKHURST NJ
07755-1654
US

IV. Provider business mailing address

40 MONMOUTH RD
OAKHURST NJ
07755-1654
US

V. Phone/Fax

Practice location:
  • Phone: 732-222-3243
  • Fax: 732-222-3019
Mailing address:
  • Phone: 732-222-3243
  • Fax: 732-222-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM A066004
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: