Provider Demographics
NPI:1992846976
Name:ISRAEL, ERNEST S (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:S
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14105 NORTHERN BLVD
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4247
Mailing Address - Country:US
Mailing Address - Phone:718-358-7271
Mailing Address - Fax:718-570-4648
Practice Address - Street 1:14105 NORTHERN BLVD
Practice Address - Street 2:SUITE 1G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4247
Practice Address - Country:US
Practice Address - Phone:718-358-7271
Practice Address - Fax:718-570-4648
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197886208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01586667Medicaid