Healthcare Provider Details

I. General information

NPI: 1174221709
Provider Name (Legal Business Name): ISABEL MARIANA GONCALVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 AUSTIN ST STE 200
FOREST HILLS NY
11375-4739
US

IV. Provider business mailing address

3635 167TH ST APT 3B
FLUSHING NY
11358-2114
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-7633
  • Fax:
Mailing address:
  • Phone: 862-316-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number033926
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: