Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 021247 | NY |
Y | 2080P0204X | Pediatric Emergency Doctor | 021247 | NY |
NPI | 1184142515 |
---|---|
Provider Name | Jasmine Samantha Isaac |
First Address | Amityville, NY 11701-1533 |
Second Address | Brooklyn, NY 11237-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 06/09/2017 |