Provider Demographics
NPI:1932305547
Name:ISSACK, PAUL S (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:ISSACK
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 1:263 7TH AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3689
Mailing Address - Country:US
Mailing Address - Phone:718-246-8700
Mailing Address - Fax:718-246-8705
Practice Address - Street 1:263 7TH AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3689
Practice Address - Country:US
Practice Address - Phone:718-246-8700
Practice Address - Fax:718-246-8705
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219508207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
6C6092OtherHEALTHNET
7147914OtherAETNA PPO
8725U1OtherBLUE SHIELD
P3849635OtherOXFORD FREEDOM, MEDICARE
00002800765OtherUNITED HEALTHCARE
0178778OtherGHI
100280076501OtherAMERICHOICE
0849138OtherCIGNA
NY02892368Medicaid
1622841OtherAETNA HMO
NY1A189EY951Medicare PIN