Ethan Isidro, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25MA10566900 Issued in NJ

Practice address

256 Columbia Tpke Ste 209
Florham Park, NJ 07932-1238

Phone

(201) 487-1240

NPI assigned

Aug 20, 2018

Last updated

Feb 9, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Psychiatric Associates LLCGroup PAC ID 8628163284, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Psychiatric Associates, LLC

  • Psychiatry Physician
  • Hackensack, NJ
  • NPI 1760673198

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Hackensack Psychiatric Group LLC

  • Psychiatry Physician
  • Hackensack, NJ
  • NPI 1063994960

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1295215150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 COEYMAN AVE",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071101514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 COLUMBIA TPKE STE 209",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321238",
            "telephone_number": "201-487-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISIDRO",
        "first_name": "ETHAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-20",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA10566900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Omar Ibrahim, MD
• Sorina Paula Ilie, DDS
• John Tyler Indrikovic, PT, DPT
• Integrated Paincare Center LLP
• Ira Hauptman DPM PC
• Maksim Ivanouski
• Hariharan Venkatachalam Iyer, M.D.
• J. G. Moreno, MD, LLC
• Gregg Andrew Jacob, D.M.D.
• Julie Jacob, APN

• Psychiatry Physician in Florham Park, NJ
• Providers in Florham Park, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.