Healthcare Provider Details

I. General information

NPI: 1114128790
Provider Name (Legal Business Name): ANNETTE ERICA ISAACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNETTE POWELL FAMILY NURSE PRACTIT

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

43 GOSHEN ST
ELMONT NY
11003-5024
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-6600
  • Fax: 212-951-6825
Mailing address:
  • Phone: 516-865-7704
  • Fax: 718-209-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: