Provider Demographics
NPI:1699075358
Name:ISAKSEN, VIRGINIA J
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:J
Last Name:ISAKSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1546
Mailing Address - Country:US
Mailing Address - Phone:732-495-4137
Mailing Address - Fax:732-495-4137
Practice Address - Street 1:500 RIVER AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4738
Practice Address - Country:US
Practice Address - Phone:732-367-1888
Practice Address - Fax:732-367-5910
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist