Healthcare Provider Details

I. General information

NPI: 1801296165
Provider Name (Legal Business Name): ARLEEN ESCUDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2014
Last Update Date: 08/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W 1ST ST
OSWEGO NY
13126-2045
US

IV. Provider business mailing address

26229 LIMESTONE RD
REDWOOD NY
13679-4100
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-9575
  • Fax:
Mailing address:
  • Phone: 315-921-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number838415141
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number838414141
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number852044141
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number852045141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: