Healthcare Provider Details

I. General information

NPI: 1073265443
Provider Name (Legal Business Name): JILLIAN ESCOBAR AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 86TH ST FL 9
NEW YORK NY
10028-7732
US

IV. Provider business mailing address

660 WHITE PLAINS ROAD ENTA 4TH FLOOR
TARRYTOWN NY
10591-6802
US

V. Phone/Fax

Practice location:
  • Phone: 347-854-0211
  • Fax:
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number003080
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: