=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578673307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW FAMILY PHYSICIANS ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 03/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5187 MAYFIELD ROAD SUITE 102
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-449-1014
-----------------------------------------------------
Fax | 440-449-8157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5187 MAYFIELD ROAD SUITE 102
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-449-1014
-----------------------------------------------------
Fax | 440-449-8157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TERENCE ISAKOV
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 440-449-1014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------