Provider Demographics
NPI:1184450223
Name:BUXBAUM, ISAAC LEE
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:LEE
Last Name:BUXBAUM
Suffix:
Gender:X
Credentials:
Other - Prefix:MS
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:BUXBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9 WARWICK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2236
Mailing Address - Country:US
Mailing Address - Phone:774-297-9748
Mailing Address - Fax:
Practice Address - Street 1:197 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2341
Practice Address - Country:US
Practice Address - Phone:774-297-9748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator