Provider Demographics
NPI:1255628962
Name:NTI, ISAIAH
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:
Last Name:NTI
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 1:1084 GERARD AVE.
Mailing Address - Street 2:APT. # C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-4617
Mailing Address - Country:US
Mailing Address - Phone:646-724-2831
Mailing Address - Fax:646-401-7418
Practice Address - Street 1:2369 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3108
Practice Address - Country:US
Practice Address - Phone:212-867-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse