Healthcare Provider Details

I. General information

NPI: 1205441714
Provider Name (Legal Business Name): ALEXANDER ESCAMILLA NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEXANDER ESCAMILLA

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 FOREST AVE
LOCUST VALLEY NY
11560-2151
US

IV. Provider business mailing address

68 E GATE DR
HUNTINGTON NY
11743-5109
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-3382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309855
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: