Provider Demographics
NPI:1093012114
Name:JEFFERSON VALLEY PODIATRY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:JEFFERSON VALLEY PODIATRY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ISAACSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-962-5571
Mailing Address - Street 1:3630 HILL BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1502
Mailing Address - Country:US
Mailing Address - Phone:914-962-5571
Mailing Address - Fax:914-962-5574
Practice Address - Street 1:3630 HILL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1502
Practice Address - Country:US
Practice Address - Phone:914-962-5571
Practice Address - Fax:914-962-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003506213E00000X
NYN002571213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty