Healthcare Provider Details

I. General information

NPI: 1730545740
Provider Name (Legal Business Name): PATRICIA ESCUDERO ROTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CENTRAL PARK W 8 Y
NEW YORK NY
10025-5880
US

IV. Provider business mailing address

400 CENTRAL PARK W APT 8Y
NEW YORK NY
10025-5833
US

V. Phone/Fax

Practice location:
  • Phone: 631-786-1116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number062736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: