Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 036770 | NY |
NPI | 1124018064 |
---|---|
Provider Name | Dr. Edward Isaac |
First Address | Huntington, NY 11743-6922 |
Second Address | Huntington, NY 11743-6922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2005 |
Last Update Date | 08/07/2007 |