Doctor Name: | AMY LYNNE ISHAK |
NPI Number: | 1043473903 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 26NJ00162600 |
Business Practice Address: | 99 Beauvoir Ave Summit, NJ - 079013533 |
Business Phone Number: | 9085225310 |
Business Fax Number: | |
Mailing Address: | 3403 Balsam Way, BASKING RIDGE |
State: | NJ |
Postal Code: | 079203157 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/09/2008 |
NPI Last Update Date: | 07/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 26NJ00162600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |