Provider Demographics
NPI:1306864491
Name:ISAACSON, SHELDON A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:A
Last Name:ISAACSON
Suffix:JR
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 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-4720
Mailing Address - Fax:315-464-4905
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-4720
Practice Address - Fax:315-464-4905
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169384207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00372225Medicaid
5302357OtherGHI PROVIDER#
NYMDA543OtherPREFERRED CARE
NY2222OtherBLUE SHIELD GROUP#
NYG0189393591OtherBLUE CHOICE PAIN GROUP#
NY7615121OtherAETNA PROVIDER#
NYP010169384OtherBLUE CHOICE
NYG0189393590OtherBLUE CHOICE GROUP#
NY01140385Medicaid
NY050011987OtherRAILROAD MEDICARE
NYMDG078OtherPREFERRED CARE PAIN#
NYE19215Medicare UPIN
NY7615121OtherAETNA PROVIDER#
NY050011987OtherRAILROAD MEDICARE
NY16538EMedicare ID - Type UnspecifiedMEDICARE