Healthcare Provider Details

I. General information

NPI: 1184184764
Provider Name (Legal Business Name): JONATHAN ROSS ISAACSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W 168TH ST
NEW YORK NY
10032-3726
US

IV. Provider business mailing address

10906 KING BAY DR
BOCA RATON FL
33498-4548
US

V. Phone/Fax

Practice location:
  • Phone: 561-901-5918
  • Fax:
Mailing address:
  • Phone: 561-901-5918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number158625
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number295358
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61687498
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD225638
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101281694
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number74081
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2025-02971
License Number StateNC
# 8
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number319274
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: