Healthcare Provider Details

I. General information

NPI: 1669075115
Provider Name (Legal Business Name): MS. ELAINA ESCALERA I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROADHOLLOW RD STE 402
MELVILLE NY
11747-4899
US

IV. Provider business mailing address

8409 106TH ST
RICHMOND HILL NY
11418-1138
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-7780
  • Fax: 631-385-7795
Mailing address:
  • Phone: 929-304-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: