Provider Demographics
NPI:1528370038
Name:ISAACS, DENA (MA OTR/L)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:ISAACS
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2705
Mailing Address - Country:US
Mailing Address - Phone:516-395-4855
Mailing Address - Fax:
Practice Address - Street 1:34 BAYBERRY RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-2705
Practice Address - Country:US
Practice Address - Phone:516-395-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010705-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker