Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 197874 | NY |
NPI | 1003800962 |
---|---|
Provider Name | Michael D Isenberg |
First Address | East Syracuse, NY 13057-4505 |
Second Address | Little Falls, NY 13365-1725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A42090 | (02) |