Provider Demographics
NPI:1225395445
Name:ADEY, ISACC BILLY
Entity Type:Individual
Prefix:
First Name:ISACC
Middle Name:BILLY
Last Name:ADEY
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 1:2505 TILDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5015
Mailing Address - Country:US
Mailing Address - Phone:718-941-4490
Mailing Address - Fax:
Practice Address - Street 1:2505 TILDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5015
Practice Address - Country:US
Practice Address - Phone:718-941-4490
Practice Address - Fax:718-703-1716
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse