Basic Information
| Provider Information | |||||||||
| NPI: | 1811564214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NILGES | ||||||||
| FirstName: | ISAAC | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP-C, MSN, CEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 W RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | CALIFORNIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650181350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738213141 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 85 W BURNSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104534015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187164400 | ||||||||
| FaxNumber: | 7187167301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2021 | ||||||||
| LastUpdateDate: | 06/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 347654 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.