Provider Demographics
NPI:1659687390
Name:ISUFI, MATILDA
Entity Type:Individual
Prefix:MS
First Name:MATILDA
Middle Name:
Last Name:ISUFI
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 1:2106 HOYT AVE S
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3430
Mailing Address - Country:US
Mailing Address - Phone:917-597-2912
Mailing Address - Fax:
Practice Address - Street 1:25 S BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3401
Practice Address - Country:US
Practice Address - Phone:908-353-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03337400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist