Healthcare Provider Details

I. General information

NPI: 1063364248
Provider Name (Legal Business Name): ESCARLE CUSTODIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W 168TH ST FL 4
NEW YORK NY
10032-3726
US

IV. Provider business mailing address

710 W 168TH ST FL 4
NEW YORK NY
10032-3726
US

V. Phone/Fax

Practice location:
  • Phone: 929-527-5312
  • Fax:
Mailing address:
  • Phone: 212-326-8941
  • Fax: 212-342-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF357876-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: