Individual
ETHAN ISIDRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
256 COLUMBIA TPKE STE 209, FLORHAM PARK, NJ 07932-1238
(201) 487-1240
Mailing address
14 COEYMAN AVE, NUTLEY, NJ 07110-1514
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
25MA10566900
NJ
Other
Enumeration date
08/20/2018
Last updated
02/09/2022
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