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General NPI Number Information
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NPI Number | 1033190855
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Entity Type | Individual
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Provider Name | MRS. LEYLA C ESCUDERO
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Gender | Female
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 40-33 76TH ST SUITE NO 4D
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City | ELMHURST
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State | NY
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Zip | 11373
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Country | US
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Telephone | 718-458-7426
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Fax | 718-672-5591
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Provider Business Mailing Address
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Address Line | 37-10 76TH ST APT 4D
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372
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Country | US
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Telephone | 718-458-0361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 043063
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License Number State | NY
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