Provider Demographics
NPI:1679729198
Name:VISAGIE, ISABELLA (PA)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:VISAGIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANINA
Other - Middle Name:S
Other - Last Name:VISAGIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2000
Mailing Address - Country:US
Mailing Address - Phone:518-828-7644
Mailing Address - Fax:518-828-1236
Practice Address - Street 1:23 FISH AND GAME RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-3815
Practice Address - Country:US
Practice Address - Phone:518-828-7644
Practice Address - Fax:518-828-1236
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant