Healthcare Provider Details

I. General information

NPI: 1851551519
Provider Name (Legal Business Name): ISADORA GUGGENHEIM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ROCKLAND PLACE
NYACK NY
10960
US

IV. Provider business mailing address

8 ROCKLAND PLACE
NYACK NY
10960
US

V. Phone/Fax

Practice location:
  • Phone: 845-893-2608
  • Fax: 845-358-2963
Mailing address:
  • Phone: 845-893-2608
  • Fax: 845-358-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF342569-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number000303
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: