Healthcare Provider Details

I. General information

NPI: 1710219787
Provider Name (Legal Business Name): LORIN AMANDA ESKIN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BANK ST APT 4W
NEW YORK NY
10014-5226
US

IV. Provider business mailing address

3959 BROADWAY # CHN723
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 845-304-7575
  • Fax:
Mailing address:
  • Phone: 212-305-3000
  • Fax: 212-342-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: