Provider Demographics
NPI:1386382554
Name:SHUSTER, ISAAC
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:SHUSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BROADWAY STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3911
Mailing Address - Country:US
Mailing Address - Phone:718-490-1497
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3914
Practice Address - Country:US
Practice Address - Phone:718-490-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063165-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist