Healthcare Provider Details

I. General information

NPI: 1265627442
Provider Name (Legal Business Name): WERNER ESCOBAR DNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CLUB LN
ROCK HILL NY
12775-6400
US

IV. Provider business mailing address

14 CLUB LN
ROCK HILL NY
12775-6400
US

V. Phone/Fax

Practice location:
  • Phone: 845-978-9664
  • Fax:
Mailing address:
  • Phone: 845-978-9664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345108-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: