Provider Demographics
NPI:1679679963
Name:ISAACSON, ERNEST LOUIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LOUIS
Last Name:ISAACSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ERNEST
Other - Middle Name:LOUIS
Other - Last Name:ISAACSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:30 PARK AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3801
Mailing Address - Country:US
Mailing Address - Phone:212-420-6002
Mailing Address - Fax:646-405-0192
Practice Address - Street 1:30 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3801
Practice Address - Country:US
Practice Address - Phone:212-420-6002
Practice Address - Fax:646-405-0192
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005935213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02478384Medicaid
NYPH6511Medicare ID - Type Unspecified
NYU95565Medicare UPIN
NY5957930001Medicare NSC