Provider Demographics
NPI:1619188802
Name:BLOCH, ISAC (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAC
Middle Name:
Last Name:BLOCH
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:MITZPE NETOFA
Mailing Address - Street 2:DN
Mailing Address - City:GALIL TACHTON
Mailing Address - State:ISRAEL
Mailing Address - Zip Code:15295
Mailing Address - Country:IL
Mailing Address - Phone:0119724-678-1581
Mailing Address - Fax:
Practice Address - Street 1:MITZPE NETOFA
Practice Address - Street 2:DN
Practice Address - City:GALIL TACHTON
Practice Address - State:ISRAEL
Practice Address - Zip Code:15295
Practice Address - Country:IL
Practice Address - Phone:0119724-678-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209610207Y00000X
ME018304207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0139220Medicaid
MA0139220Medicaid
MAH40330Medicare UPIN