Healthcare Provider Details

I. General information

NPI: 1548400302
Provider Name (Legal Business Name): MR. MICHAEL ELVIN ISAACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WESTCHESTER SQ
BRONX NY
10461-3525
US

IV. Provider business mailing address

1575 ODELL ST APT 9G
BRONX NY
10462-7044
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-4045
  • Fax:
Mailing address:
  • Phone: 347-236-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: