Healthcare Provider Details

I. General information

NPI: 1598052292
Provider Name (Legal Business Name): CHARBEL ISHAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SELWYN AVE
BRONX NY
10457-7626
US

IV. Provider business mailing address

52 MAIN ST
BEDFORD HILLS NY
10507-1814
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1100
  • Fax: 612-294-4903
Mailing address:
  • Phone: 914-666-2220
  • Fax: 914-666-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number266333
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number266333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: