Provider Demographics
NPI:1417929092
Name:ISRALOWITZ, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:ISRALOWITZ
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 1:128 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1565
Mailing Address - Country:US
Mailing Address - Phone:201-939-8834
Mailing Address - Fax:201-939-7644
Practice Address - Street 1:128 UNION AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1565
Practice Address - Country:US
Practice Address - Phone:201-939-8834
Practice Address - Fax:201-939-7644
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4746503Medicaid
C59783Medicare UPIN
NJ4746503Medicaid