Provider Demographics
NPI:1588174726
Name:ADIGWE, ISIS (MSE)
Entity type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:ADIGWE
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:ISIS
Other - Middle Name:
Other - Last Name:SHORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSE, MED
Mailing Address - Street 1:2007 E 60TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2007 E 60TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4109
Practice Address - Country:US
Practice Address - Phone:718-772-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist