Ison, Theron

Ison, Theron is an individual health care provider with primary practice located at 9729 64Th Rd , Rego Park NY 11374-2240. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Ison, Theron can be contacted via phone (718) 896-3400.

Contact Information

Primary practice address
9729 64Th Rd Rego Park NY 11374-2240
Phone: (718) 896-3400
Fax: (718) 459-5621
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 17336 New York

Profile Details

NPI number 1598083123
LBN Legal business name Ison, Theron
Credentials CASAC
Entity Individual
Sole proprietor 1 No
Enumeration date May 6th, 2010
Last updated May 6th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598083123 NPPES
New York MEDICAID 00244019

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