Healthcare Provider Details

I. General information

NPI: 1306339056
Provider Name (Legal Business Name): DAVID Y ISSEVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7736 169TH ST STE 1
FRESH MEADOWS NY
11366-1372
US

IV. Provider business mailing address

7736 169TH ST STE 1
FRESH MEADOWS NY
11366-1372
US

V. Phone/Fax

Practice location:
  • Phone: 718-878-4656
  • Fax: 718-889-7444
Mailing address:
  • Phone: 718-878-4656
  • Fax: 718-889-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number3591776
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number3591776
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: