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General NPI Number Information
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NPI Number | 1952505968
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Entity Type | Organization
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Legal Business Name | ISAK ISAKOV MEDICAL, PC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 62-60 108TH STREET SUITE 1J
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City | FOREST HILLS
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State | NY
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Zip | 11375
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Country | US
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Telephone | 718-275-2224
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Fax | 718-275-5100
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Provider Business Mailing Address
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Address Line | 62-60 108TH STREET SUITE 1J
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City | FOREST HILLS
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State | NY
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Zip | 11375
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Country | US
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Telephone | 718-275-2224
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Fax | 718-275-5100
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. ISAKS ISAKOV
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Credential | M.D
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Telephone | 718-275-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 220352-1
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License Number State | NY
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