Healthcare Provider Details

I. General information

NPI: 1407173578
Provider Name (Legal Business Name): GARY SEAN ESCOLA M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SEAN ESCOLA M.D., PH.D.

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W 86TH ST APT 1004
NEW YORK NY
10024-3743
US

IV. Provider business mailing address

51 W 86TH ST APT 1004
NEW YORK NY
10024-3743
US

V. Phone/Fax

Practice location:
  • Phone: 917-587-4371
  • Fax:
Mailing address:
  • Phone: 917-587-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number261908
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: