Provider Demographics
NPI:1568780104
Name:ISAAC, MAHROS K (PT)
Entity Type:Individual
Prefix:
First Name:MAHROS
Middle Name:K
Last Name:ISAAC
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 BANTA ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1918
Mailing Address - Country:US
Mailing Address - Phone:201-803-7008
Mailing Address - Fax:201-786-9222
Practice Address - Street 1:537 BANTA ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1918
Practice Address - Country:US
Practice Address - Phone:201-803-7008
Practice Address - Fax:201-786-9222
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist