Provider Demographics
NPI:1316355779
Name:ROMAN ISAAC, MD
Entity Type:Organization
Organization Name:ROMAN ISAAC, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:EUDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-759-4553
Mailing Address - Street 1:205 E 64TH ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6635
Mailing Address - Country:US
Mailing Address - Phone:212-759-4553
Mailing Address - Fax:212-759-1353
Practice Address - Street 1:205 E 64TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6635
Practice Address - Country:US
Practice Address - Phone:212-759-4553
Practice Address - Fax:212-759-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275010-1261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty