Provider Demographics
NPI:1114906377
Name:FLORENCE, ISAIAH (MD)
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:
Last Name:FLORENCE
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 1:222 CEDAR LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4314
Mailing Address - Country:US
Mailing Address - Phone:201-287-1100
Mailing Address - Fax:201-586-0409
Practice Address - Street 1:222 CEDAR LN
Practice Address - Street 2:SUITE 210
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4314
Practice Address - Country:US
Practice Address - Phone:201-287-1100
Practice Address - Fax:201-586-0409
Is Sole Proprietor?:No
Enumeration Date:2006-01-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06705700207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8432309Medicaid
NJ050061049OtherRAILROAD MEDICARE
NJ011107Medicare ID - Type UnspecifiedMEDICARE
NJ050061049OtherRAILROAD MEDICARE