Healthcare Provider Details

I. General information

NPI: 1629339569
Provider Name (Legal Business Name): ALBA I ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LORRAINE AVE
MOUNT VERNON NY
10553-1222
US

IV. Provider business mailing address

76 CARYL AVE
YONKERS NY
10705-4149
US

V. Phone/Fax

Practice location:
  • Phone: 914-963-7070
  • Fax: 914-963-7075
Mailing address:
  • Phone: 914-968-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: