Provider Demographics
NPI:1629287990
Name:ISSEROFF, HILLEL NOAH (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:HILLEL
Middle Name:NOAH
Last Name:ISSEROFF
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4332
Mailing Address - Country:US
Mailing Address - Phone:718-778-7272
Mailing Address - Fax:718-773-4583
Practice Address - Street 1:358 KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4332
Practice Address - Country:US
Practice Address - Phone:718-778-7272
Practice Address - Fax:718-773-4583
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08168800208VP0014X, 207R00000X
NY246144207R00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02981340Medicaid
NYA400004008Medicare PIN