Healthcare Provider Details

I. General information

NPI: 1366717290
Provider Name (Legal Business Name): JULIET B. ESCALON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2012
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E 102ND ST
NEW YORK NY
10029-6030
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 3000
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6756
  • Fax:
Mailing address:
  • Phone: 212-987-3100
  • Fax: 212-731-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303797-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: