Healthcare Provider Details

I. General information

NPI: 1871174458
Provider Name (Legal Business Name): DENNIS ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 MIDVALE AVE
EAST MEADOW NY
11554-5317
US

IV. Provider business mailing address

624 MIDVALE AVE
EAST MEADOW NY
11554-5317
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-7467
  • Fax:
Mailing address:
  • Phone: 516-395-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: