Healthcare Provider Details

I. General information

NPI: 1861659518
Provider Name (Legal Business Name): KERRY ESQUITIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

630 W 168TH ST BOX 4
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-4749
  • Fax: 212-746-6692
Mailing address:
  • Phone: 212-746-4749
  • Fax: 212-746-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number249285
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: