Healthcare Provider Details

I. General information

NPI: 1811702293
Provider Name (Legal Business Name): WANDA I ESCALERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 21ST ST
NORTH BERGEN NJ
07047-2092
US

IV. Provider business mailing address

1110 21ST ST
NORTH BERGEN NJ
07047-2092
US

V. Phone/Fax

Practice location:
  • Phone: 917-370-4486
  • Fax:
Mailing address:
  • Phone: 917-370-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: