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General NPI Number Information
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NPI Number | 1164423448
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Entity Type | Individual
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Provider Name | THEODORE N ISSEKS MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 5518 STATE ROUTE 55
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City | LIBERTY
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State | NY
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Zip | 12754
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Country | US
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Telephone | 845-292-3011
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Fax | 845-292-1821
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Provider Business Mailing Address
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Address Line | 5518 STATE ROUTE 55
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City | LIBERTY
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State | NY
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Zip | 12754
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Country | US
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Telephone | 845-292-3011
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Fax | 845-292-1821
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 117110
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License Number State | NY
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