Provider Demographics
NPI:1053612804
Name:HENRY U. ISIOCHA LLC
Entity type:Organization
Organization Name:HENRY U. ISIOCHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:U
Authorized Official - Last Name:ISIOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-747-7903
Mailing Address - Street 1:1177B S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6903
Mailing Address - Country:US
Mailing Address - Phone:302-747-7903
Mailing Address - Fax:302-747-7906
Practice Address - Street 1:1177B S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6903
Practice Address - Country:US
Practice Address - Phone:302-747-7903
Practice Address - Fax:302-747-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005027302F00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service