Provider Demographics
NPI:1154200020
Name:ISAACSON, ETHAN VANCE I
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:VANCE
Last Name:ISAACSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 CARROUSEL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NEW MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44442-7735
Mailing Address - Country:US
Mailing Address - Phone:330-885-4743
Mailing Address - Fax:
Practice Address - Street 1:1 TRESSEL WAY
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44555-9703
Practice Address - Country:US
Practice Address - Phone:330-941-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program