Healthcare Provider Details

I. General information

NPI: 1518428788
Provider Name (Legal Business Name): JOSEPH GABRIEL ESCOBAR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 HOUSTON RD
WEBSTER NY
14580-4041
US

IV. Provider business mailing address

196 SHARON DR
ROCHESTER NY
14626-2035
US

V. Phone/Fax

Practice location:
  • Phone: 607-742-2635
  • Fax:
Mailing address:
  • Phone: 585-851-9276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number677747
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: