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General NPI Number Information
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NPI Number | 1013143155
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Entity Type | Organization
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Legal Business Name | CITIVIEW FAMILY MEDICAL, PLLC
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 4132 44TH ST 1ST FLOOR
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City | SUNNYSIDE
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State | NY
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Zip | 11104-2203
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Country | US
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Telephone | 347-832-0192
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Fax | 347-242-2765
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Provider Business Mailing Address
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Address Line | 4132 44TH ST 1ST FLOOR
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City | SUNNYSIDE
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State | NY
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Zip | 11104-2203
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Country | US
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Telephone | 347-832-0192
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Fax | 347-242-2765
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. HERMANN ESCOBAR
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Credential | D.O.
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Telephone | 347-832-0192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 221341
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License Number State | NY
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