Healthcare Provider Details

I. General information

NPI: 1285213793
Provider Name (Legal Business Name): MARLYN TABLO ESCALONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 04/03/2021
Certification Date: 04/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LINCOLN ST
SPRING VALLEY NY
10977-5822
US

IV. Provider business mailing address

8 LINCOLN ST
SPRING VALLEY NY
10977-5822
US

V. Phone/Fax

Practice location:
  • Phone: 973-931-9001
  • Fax:
Mailing address:
  • Phone: 973-931-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ01132500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: