Healthcare Provider Details

I. General information

NPI: 1437834397
Provider Name (Legal Business Name): ELCHANAN YOCHANAN ESKENAZI LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 LATCHES LN
BALA CYNWYD PA
19004-3015
US

IV. Provider business mailing address

164 LATCHES LN
BALA CYNWYD PA
19004-3015
US

V. Phone/Fax

Practice location:
  • Phone: 917-579-9579
  • Fax:
Mailing address:
  • Phone: 610-664-3549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06888100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW139723
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: