Provider Demographics
NPI:1063945798
Name:ISENBURG, DANIELLE (DO)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:ISENBURG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 ULSTER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1517
Mailing Address - Country:US
Mailing Address - Phone:845-768-1990
Mailing Address - Fax:
Practice Address - Street 1:1240 ULSTER AVE STE 104
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1517
Practice Address - Country:US
Practice Address - Phone:845-768-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine