Healthcare Provider Details

I. General information

NPI: 1952596280
Provider Name (Legal Business Name): JUAN T. ESTEVEZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E FORDHAM RD FL 2
BRONX NY
10458-5033
US

IV. Provider business mailing address

43 HAYHURST DR
NEW ROCHELLE NY
10804-2001
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-3826
  • Fax: 718-584-7309
Mailing address:
  • Phone: 914-235-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number199868
License Number StateNY

VIII. Authorized Official

Name: DR. JUAN T ESTEVEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 914-310-3418