Active NPI
Marc Isralsky, PH.D.
- Psychologist
- Marietta, GA
National Provider Identifier
1821272204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1090
- Practice address
- 840 Church St NE
Building F
Marietta, GA 30060-8936 - Phone
- (770) 428-8417
- Fax
- (770) 565-3090
- NPI assigned
- Dec 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1090 | GA | Primary |
Addresses
Primary practice location
840 Church St NE
Building F
Marietta, GA 30060-8936
Mailing address
840 Church St NE
Building F
Marietta, GA 30060-8936
Phone (770) 428-8417
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00341404A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1090 | GA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198108800000",
"number": "1821272204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "840 CHURCH ST NE",
"address_2": "BUILDING F",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300608936",
"telephone_number": "770-428-8417",
"fax_number": "770-565-3090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 CHURCH ST NE",
"address_2": "BUILDING F",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300608936",
"telephone_number": "770-428-8417",
"fax_number": "770-565-3090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISRALSKY",
"first_name": "MARC",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-20",
"last_updated": "2007-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "1090",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00341404A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.