MEDICARE: JOSE ISIDRO MD

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	207L00000X	Anesthesiology Physician	25MA04749000	NJ
2	208VP0014X	Interventional Pain Medicine Physician	25MA04749000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558337972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ISIDRO MD

Provider Business Mailing Address
First Line	:	28 NEW BROOKLYN RD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-2254
Country	:	US
Telephone Number	:	732-318-6869
Fax Number	:	732-494-9112

Provider Business Practice Location Address
First Line	:	2 LINCOLN HWY
Second Line	:	# 109
City	:	EDISON
State	:	NJ
Zip	:	08820-3961
Country	:	US
Telephone Number	:	732-318-6869
Fax Number	:	732-494-9112

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

Provider Enumeration Date	:	02/25/2006
Last Update Date	:	12/01/2017

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Directions to “ JOSE ISIDRO MD” Practice Location

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