Healthcare Provider Details

I. General information

NPI: 1578276937
Provider Name (Legal Business Name): GEORGE ESKANDAR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ISLAND RD STE 2B
RAMSEY NJ
07446-2822
US

IV. Provider business mailing address

545 ISLAND RD STE 2B
RAMSEY NJ
07446-2822
US

V. Phone/Fax

Practice location:
  • Phone: 201-995-1004
  • Fax: 201-345-7121
Mailing address:
  • Phone: 510-759-4014
  • Fax: 201-345-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1190491
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00802200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: