Theodore N Isseks, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

117110 Issued in NY

Practice address

5518 State Route 55
Liberty, NY 12754

Phone

(845) 292-3011

Fax

(845) 292-1821

NPI assigned

Aug 9, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Theodore N Isseks Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294185600000",
    "number": "1164423448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5518 STATE ROUTE 55",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "12754",
            "telephone_number": "845-292-3011",
            "fax_number": "845-292-1821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5518 STATE ROUTE 55",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "12754",
            "telephone_number": "845-292-3011",
            "fax_number": "845-292-1821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISSEKS",
        "first_name": "THEODORE",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2011-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "117110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00248233",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THEODORE",
            "last_name": "ISSEKS",
            "middle_name": "N",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jill M Holland, COTA
• Renee Hook, FNP
• Tiffany Anne Huebsch, RN
• Hussein Omar, Physician, P.C.
• Internal Medicine Hematology and Cancer Care PC
• Jack & Jill Developmental Services, SLP, OT & Psychology, PLLP
• Jack and Jill Developmental Services
• Sandhya Jakka, PT
• Jill Harmon, LCSW, PC
• Katherine Noreen Johnson, LCSW

• Ophthalmology Physician in Liberty, NY
• Providers in Liberty, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.