Healthcare Provider Details

I. General information

NPI: 1962396598
Provider Name (Legal Business Name): ESSE INTEGRATED REPRODUCTIVE SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 5TH AVE
NEW YORK NY
10017-3620
US

IV. Provider business mailing address

204 CORLIES AVE
PELHAM NY
10803-1904
US

V. Phone/Fax

Practice location:
  • Phone: 646-844-9602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON PROVOST
Title or Position: COO
Credential:
Phone: 832-515-6129