Provider Demographics
NPI:1447987359
Name:ISAKOVA, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ISAKOVA
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 1:249 OCEAN PKWY APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3212
Mailing Address - Country:US
Mailing Address - Phone:917-714-4957
Mailing Address - Fax:
Practice Address - Street 1:249 OCEAN PKWY APT 2B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3212
Practice Address - Country:US
Practice Address - Phone:917-714-4957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00955376374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide