Healthcare Provider Details

I. General information

NPI: 1801057781
Provider Name (Legal Business Name): ISAAC EZON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MONMOUTH RD SUITE 102
WEST LONG BRANCH NJ
07764-1177
US

IV. Provider business mailing address

241 MONMOUTH RD SUITE 102
WEST LONG BRANCH NJ
07764-1177
US

V. Phone/Fax

Practice location:
  • Phone: 732-738-4627
  • Fax: 888-604-9076
Mailing address:
  • Phone: 732-738-4627
  • Fax: 888-604-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA09591700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number25MA09591700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: