Provider Demographics
NPI:1093783409
Name:ISDANER, NEIL L (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:L
Last Name:ISDANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 CENTRAL AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2443
Mailing Address - Country:US
Mailing Address - Phone:215-745-7411
Mailing Address - Fax:215-745-7488
Practice Address - Street 1:7602 CENTRAL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2443
Practice Address - Country:US
Practice Address - Phone:215-745-7411
Practice Address - Fax:215-745-7488
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017922E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA47074OtherKEYSTONE MERCY
PA05971OtherUSHC
PA0052872000OtherKEYSTONE/PERSONAL CHOICE
PA119046Medicare ID - Type Unspecified
PA47074OtherKEYSTONE MERCY