Provider Demographics
NPI:1093508723
Name:ADZAHO, ISAAC (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:ADZAHO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HUNTINGTON TER APT 3F
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1870
Mailing Address - Country:US
Mailing Address - Phone:973-444-0480
Mailing Address - Fax:
Practice Address - Street 1:163 HUNTINGTON TER APT 3F
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-1870
Practice Address - Country:US
Practice Address - Phone:973-444-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15330600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health