Healthcare Provider Details

I. General information

NPI: 1821707357
Provider Name (Legal Business Name): JOEL ISAACSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S 4TH ST
NEWARK OH
43055-5002
US

IV. Provider business mailing address

4214 E MAIN ST
COLUMBUS OH
43213-3028
US

V. Phone/Fax

Practice location:
  • Phone: 380-201-1313
  • Fax:
Mailing address:
  • Phone: 614-334-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: