Provider Demographics
NPI:1295097616
Name:NEIL L. ISDANER, MD. PC
Entity type:Organization
Organization Name:NEIL L. ISDANER, MD. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:ISDANER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-745-7411
Mailing Address - Street 1:7602 CENTRAL AVE
Mailing Address - Street 2:STAPLEY BLDG ST 103
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2443
Mailing Address - Country:US
Mailing Address - Phone:215-745-7411
Mailing Address - Fax:215-745-7288
Practice Address - Street 1:7602 CENTRAL AVE
Practice Address - Street 2:STAPLEY BLDG ST 103
Practice Address - City:PHILLA
Practice Address - State:PA
Practice Address - Zip Code:19111-2443
Practice Address - Country:US
Practice Address - Phone:215-745-7411
Practice Address - Fax:215-745-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017922E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37118Medicare UPIN