MEDICARE: DR. LESTHIA ISAACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	022906	NY

General Provider Information

NPI Number	:	1275069148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESTHIA ISAACS

Provider Business Mailing Address
First Line	:	9750 TRANSIT RD
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9750 TRANSIT RD
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1311
Country	:	US
Telephone Number	:	716-636-1375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	03/26/2020

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