Healthcare Provider Details

I. General information

NPI: 1073314472
Provider Name (Legal Business Name): SCHADIQUE ESCOFFERY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WILLOWBROOK RD
QUEENSBURY NY
12804-5882
US

IV. Provider business mailing address

22 US OVAL STE 100
PLATTSBURGH NY
12903-5901
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number156.0134401
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: