Healthcare Provider Details

I. General information

NPI: 1003732694
Provider Name (Legal Business Name): NICOLE ISAAC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 CEDAR LN STE A
TEANECK NJ
07666-1712
US

IV. Provider business mailing address

2 KINDERKAMACK RD UNIT 433 APT 433
HACKENSACK NJ
07601-4869
US

V. Phone/Fax

Practice location:
  • Phone: 201-836-6400
  • Fax:
Mailing address:
  • Phone: 862-596-2558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15567800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: