Healthcare Provider Details

I. General information

NPI: 1437258985
Provider Name (Legal Business Name): HERMANN ESCOBAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/21/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 31ST ST
ASTORIA NY
11105-2765
US

IV. Provider business mailing address

2318 31ST ST
ASTORIA NY
11105-2765
US

V. Phone/Fax

Practice location:
  • Phone: 718-204-2200
  • Fax: 718-204-2218
Mailing address:
  • Phone: 718-204-2200
  • Fax: 718-204-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number221341-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: