Provider Demographics
NPI:1841441052
Name:ISACKS, BRYAN L JR (MS, LAC)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:L
Last Name:ISACKS
Suffix:JR
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8193 COUNTY ROAD 129
Mailing Address - Street 2:
Mailing Address - City:INTERLAKEN
Mailing Address - State:NY
Mailing Address - Zip Code:14847-9502
Mailing Address - Country:US
Mailing Address - Phone:607-592-3943
Mailing Address - Fax:
Practice Address - Street 1:203 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886-8908
Practice Address - Country:US
Practice Address - Phone:607-592-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003645-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist