Provider Demographics
NPI:1417160839
Name:HAMMOND, ISAAC JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:HAMMOND
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RUTLAND ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1810
Mailing Address - Country:US
Mailing Address - Phone:718-470-5790
Mailing Address - Fax:
Practice Address - Street 1:1111 MARCUS AVE STE M15
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1034
Practice Address - Country:US
Practice Address - Phone:516-601-7304
Practice Address - Fax:718-470-5790
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09104-1363A00000X
CAPA57835363AS0400X
RIPA 00378363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP86876Medicare UPIN