Provider Demographics
NPI:1700095924
Name:ISAACS, SUSANNA (DDS)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:ISAACS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 WILLIS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1930
Mailing Address - Country:US
Mailing Address - Phone:516-746-3616
Mailing Address - Fax:516-746-3616
Practice Address - Street 1:864 WILLIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1930
Practice Address - Country:US
Practice Address - Phone:516-746-3616
Practice Address - Fax:516-746-3616
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0514501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice