Provider Demographics
NPI:1124327721
Name:ISAAC, CHANTAL M
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:M
Last Name:ISAAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 OCEAN AVE
Mailing Address - Street 2:APT 5D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4979
Mailing Address - Country:US
Mailing Address - Phone:718-825-5734
Mailing Address - Fax:
Practice Address - Street 1:755 OCEAN AVE
Practice Address - Street 2:APT 5D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4979
Practice Address - Country:US
Practice Address - Phone:718-825-5734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304385164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse