Provider Demographics
NPI:1871664508
Name:PATHAK, ISHA (MD)
Entity Type:Individual
Prefix:
First Name:ISHA
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3005
Mailing Address - Country:US
Mailing Address - Phone:516-801-2530
Mailing Address - Fax:516-801-2530
Practice Address - Street 1:3400 BRUSH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1712
Practice Address - Country:US
Practice Address - Phone:516-213-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02577439Medicaid
NY02577439Medicaid
NYG95214Medicare UPIN