Healthcare Provider Details

I. General information

NPI: 1770490724
Provider Name (Legal Business Name): MORDECHAI IZSAK NP IN PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 59TH ST
BROOKLYN NY
11204-2382
US

IV. Provider business mailing address

1903 59TH ST
BROOKLYN NY
11204-2382
US

V. Phone/Fax

Practice location:
  • Phone: 646-504-4440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MORDECHAI IZSAK
Title or Position: OWNER
Credential: NP
Phone: 646-504-4440