Provider Demographics
NPI:1992146799
Name:VAIL, ISAIAH J
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:J
Last Name:VAIL
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 1:2280 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9206
Mailing Address - Country:US
Mailing Address - Phone:518-456-5056
Mailing Address - Fax:518-456-6512
Practice Address - Street 1:634 PLANK RD STE 206
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4881
Practice Address - Country:US
Practice Address - Phone:518-456-5056
Practice Address - Fax:518-456-6512
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health