Healthcare Provider Details

I. General information

NPI: 1447179593
Provider Name (Legal Business Name): PROFESSIONAL FAMILY HEALTH NP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86100 MARENGO ST
HOLLIS NY
11423-1437
US

IV. Provider business mailing address

7635 168TH ST
FRESH MEADOWS NY
11366-1333
US

V. Phone/Fax

Practice location:
  • Phone: 917-822-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA ISAKOV
Title or Position: NP
Credential: NP
Phone: 917-822-6400