Provider Demographics
NPI:1851127740
Name:GONSALVES, ISAIAH
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:
Last Name:GONSALVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LANCASTER ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-4333
Mailing Address - Country:US
Mailing Address - Phone:518-605-3043
Mailing Address - Fax:
Practice Address - Street 1:110 LANCASTER ST APT 2F
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-4333
Practice Address - Country:US
Practice Address - Phone:518-605-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator