Provider Demographics
NPI:1962576611
Name:ISAKOV, GALINA (MD)
Entity type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:ISAKOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6538 BOOTH ST
Mailing Address - Street 2:APT 2 G
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4162
Mailing Address - Country:US
Mailing Address - Phone:718-459-0878
Mailing Address - Fax:
Practice Address - Street 1:1900 2ND AVE
Practice Address - Street 2:NEW YORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7406
Practice Address - Country:US
Practice Address - Phone:212-423-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2070242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY207024OtherLICENSE