Healthcare Provider Details

I. General information

NPI: 1114991924
Provider Name (Legal Business Name): GLORIA M ESCAMILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E PULASKI RD
HUNTINGTON STATION NY
11746-1915
US

IV. Provider business mailing address

180 E PULASKI RD
HUNTINGTON STATION NY
11746-1915
US

V. Phone/Fax

Practice location:
  • Phone: 631-499-8181
  • Fax: 631-499-6863
Mailing address:
  • Phone: 631-499-8181
  • Fax: 631-499-6863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number197325
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number197325
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number197325
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: