MEDICARE: ISABELLA LOUISSAINT MSED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	218814	NY

General Provider Information

NPI Number	:	1962879650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABELLA LOUISSAINT MSED

Provider Business Mailing Address
First Line	:	22135 90TH AVE
Second Line	:	APT 2C
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1324
Country	:	US
Telephone Number	:	347-644-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	22135 90TH AVE
Second Line	:	APT 2C
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1324
Country	:	US
Telephone Number	:	347-644-3370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	08/28/2015

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