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General NPI Number Information
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NPI Number | 1891227682
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Entity Type | Organization
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Legal Business Name | FARRA ISAACSON, DDS PLLC
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 1150 PORTION RD SUITE 15
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City | HOLTSVILLE
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State | NY
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Zip | 11742-1074
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Country | US
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Telephone | 631-696-3820
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Fax | 631-696-7780
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Provider Business Mailing Address
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Address Line | 1150 PORTION RD SUITE 15
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City | HOLTSVILLE
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State | NY
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Zip | 11742-1074
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Country | US
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Telephone | 631-696-3820
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Fax | 631-696-7780
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Authorized Official
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Title or Position | ONWER/DENTIST
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Name | DR. FARRA ISAACSON
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Credential | DDS
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Telephone | 631-696-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 049280
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License Number State | NY
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