Healthcare Provider Details

I. General information

NPI: 1891278883
Provider Name (Legal Business Name): CHRISTOPHER DEGUZMAN ESLIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N 1ST ST
NEW HYDE PARK NY
11040-2819
US

IV. Provider business mailing address

545 N 1ST ST
NEW HYDE PARK NY
11040-2819
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-1771
  • Fax:
Mailing address:
  • Phone: 516-395-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number022558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: