Provider Demographics
NPI:1659423994
Name:ISAACOFF, THEODORE ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ROBERT
Last Name:ISAACOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 LIMEKILN PIKE
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1007
Mailing Address - Country:US
Mailing Address - Phone:267-419-8360
Mailing Address - Fax:
Practice Address - Street 1:1426 W ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-1714
Practice Address - Country:US
Practice Address - Phone:215-228-2800
Practice Address - Fax:215-228-2050
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001656-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00506941Medicaid
PA00506941Medicaid
PAT58673Medicare UPIN