Provider Demographics
NPI:1659688968
Name:ISAKOV, EDWARD (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:ISAKOV
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 63RD DR APT C7
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2202
Mailing Address - Country:US
Mailing Address - Phone:646-331-4405
Mailing Address - Fax:
Practice Address - Street 1:9711 63RD DR APT C7
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2202
Practice Address - Country:US
Practice Address - Phone:646-331-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist