Provider Demographics
NPI:1972329423
Name:MARI-JATA, ISAAC
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:MARI-JATA
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 1:140 ELGAR PL APT 10L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5235
Mailing Address - Country:US
Mailing Address - Phone:929-241-7745
Mailing Address - Fax:
Practice Address - Street 1:140 ELGAR PL APT 10L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5235
Practice Address - Country:US
Practice Address - Phone:929-241-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty