Healthcare Provider Details

I. General information

NPI: 1891227682
Provider Name (Legal Business Name): FARRA ISAACSON, DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 PORTION RD SUITE 15
HOLTSVILLE NY
11742-1074
US

IV. Provider business mailing address

1150 PORTION RD SUITE 15
HOLTSVILLE NY
11742-1074
US

V. Phone/Fax

Practice location:
  • Phone: 631-696-3820
  • Fax: 631-696-7780
Mailing address:
  • Phone: 631-696-3820
  • Fax: 631-696-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number049280
License Number StateNY

VIII. Authorized Official

Name: DR. FARRA ISAACSON
Title or Position: ONWER/DENTIST
Credential: DDS
Phone: 631-696-3820