Healthcare Provider Details

I. General information

NPI: 1962443127
Provider Name (Legal Business Name): JUAN A ESCARFULLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E FORDHAM RD
BRONX NY
10458-5049
US

IV. Provider business mailing address

625 E FORDHAM RD
BRONX NY
10458-5049
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-1900
  • Fax: 718-563-4039
Mailing address:
  • Phone: 718-933-1900
  • Fax: 718-563-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4051R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number281318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: