Healthcare Provider Details

I. General information

NPI: 1649740374
Provider Name (Legal Business Name): KYLE RAYMOND ESKRIDGE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 ROUTE 25A STE 13
WADING RIVER NY
11792-2008
US

IV. Provider business mailing address

38A GRANT AVE
BETHPAGE NY
11714-2624
US

V. Phone/Fax

Practice location:
  • Phone: 631-886-2844
  • Fax:
Mailing address:
  • Phone: 516-474-6273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number023000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: