Healthcare Provider Details

I. General information

NPI: 1043017676
Provider Name (Legal Business Name): RANDY ESKENAZI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 SUNSET LN
RIDGEFIELD CT
06877-4607
US

IV. Provider business mailing address

47 SUNSET LN
RIDGEFIELD CT
06877-4607
US

V. Phone/Fax

Practice location:
  • Phone: 914-980-2269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001781
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: