Healthcare Provider Details

I. General information

NPI: 1689812398
Provider Name (Legal Business Name): WILLIAM ESCHEN M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 LEXINGTON AVE SAINT PETER'S CHURCH
NEW YORK NY
10022-4613
US

IV. Provider business mailing address

619 LEXINGTON AVE SAINT PETER'S CHURCH
NEW YORK NY
10022-4613
US

V. Phone/Fax

Practice location:
  • Phone: 212-217-0957
  • Fax:
Mailing address:
  • Phone: 212-217-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001787
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: