Provider Demographics
NPI:1659518918
Name:ITSHAK, GEORGI
Entity Type:Individual
Prefix:
First Name:GEORGI
Middle Name:
Last Name:ITSHAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116-27 METROPOLITAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415
Mailing Address - Country:US
Mailing Address - Phone:718-847-1132
Mailing Address - Fax:
Practice Address - Street 1:116-27 METROPOLITAN AVENUE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415
Practice Address - Country:US
Practice Address - Phone:718-847-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies