Healthcare Provider Details

I. General information

NPI: 1255051587
Provider Name (Legal Business Name): MORDECHAI IZSAK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 FLATLANDS AVE
BROOKLYN NY
11234-3507
US

IV. Provider business mailing address

3709 FLATLANDS AVE
BROOKLYN NY
11234-3507
US

V. Phone/Fax

Practice location:
  • Phone: 718-444-7766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351232
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number745604
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407728
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: