Healthcare Provider Details

I. General information

NPI: 1285579540
Provider Name (Legal Business Name): HANIFAH ISSAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 COURTLANDT AVE FL 4
BRONX NY
10451-5007
US

IV. Provider business mailing address

529 COURTLANDT AVE FL 4
BRONX NY
10451-5007
US

V. Phone/Fax

Practice location:
  • Phone: 347-818-1191
  • Fax:
Mailing address:
  • Phone: 347-818-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: