Healthcare Provider Details

I. General information

NPI: 1801843859
Provider Name (Legal Business Name): ALBERTO ESQUENAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E OLNEY AVE SUITE 400
PHILADELPHIA PA
19120-2421
US

IV. Provider business mailing address

60 TOWNSHIP LINE RD
ELKINS PARK PA
19027-2220
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7000
  • Fax: 215-254-2599
Mailing address:
  • Phone: 215-663-6600
  • Fax: 215-456-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD035480L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: