Provider Demographics
NPI:1477562718
Name:GORBATY, ISAAC (MD)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:GORBATY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18411 CLARK STREET
Mailing Address - Street 2:206
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-708-3143
Mailing Address - Fax:818-708-3146
Practice Address - Street 1:18411 CLARK STREET
Practice Address - Street 2:206
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-708-3143
Practice Address - Fax:818-708-3146
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33719207RG0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG33719OtherMEDICAL LICENSE
CAG33719Medicaid
CAG33719Medicaid
CAG33719OtherMEDICAL LICENSE
CAAG1235868OtherDEA NUMBER