Healthcare Provider Details

I. General information

NPI: 1710670708
Provider Name (Legal Business Name): GLEEMARIE ESCARDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 12/15/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107-02 R JAMAICA AVE
RICHMOND HILL NY
11418
US

IV. Provider business mailing address

107-02 R JAMAICA AVE
RICHMOND HILL NY
11418
US

V. Phone/Fax

Practice location:
  • Phone: 347-829-3890
  • Fax: 347-829-3888
Mailing address:
  • Phone: 347-829-3890
  • Fax: 347-829-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: