Healthcare Provider Details

I. General information

NPI: 1417219593
Provider Name (Legal Business Name): MRS. SARAH JORDAN LAKE ESKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH JORDAN LAKE MSED

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W 32ND ST 8TH FLOOR
NEW YORK NY
10001-3212
US

IV. Provider business mailing address

350 7TH ST APT. 4B
HOBOKEN NJ
07030-2890
US

V. Phone/Fax

Practice location:
  • Phone: 917-362-6046
  • Fax:
Mailing address:
  • Phone: 201-683-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1698646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: