Healthcare Provider Details

I. General information

NPI: 1346501376
Provider Name (Legal Business Name): MRS. ELIZABETH ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 OAKTREE LN
LEVITTOWN NY
11756-1520
US

IV. Provider business mailing address

17 OAKTREE LN
LEVITTOWN NY
11756-1520
US

V. Phone/Fax

Practice location:
  • Phone: 516-520-0408
  • Fax:
Mailing address:
  • Phone: 516-520-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: