Healthcare Provider Details

I. General information

NPI: 1699813642
Provider Name (Legal Business Name): INTERNATIONAL SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WESTCHESTER AVE
BRONX NY
10461-4500
US

IV. Provider business mailing address

3250 WESTCHESTER AVE
BRONX NY
10461-4500
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-9304
  • Fax:
Mailing address:
  • Phone: 718-518-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number160910
License Number StateNY

VIII. Authorized Official

Name: KATHY BAEZ
Title or Position: COO
Credential:
Phone: 516-693-0700