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General NPI Number Information
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NPI Number | 1043209729
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Entity Type | Individual
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Provider Name | ERNESTO AQUIATAN NUEVA ESPANA MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 5401 PALISADE AVE
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City | RIVERDALE
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State | NY
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Zip | 10471-1214
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Country | US
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Telephone | 718-581-1200
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Fax | 718-581-1012
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Provider Business Mailing Address
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Address Line | 159 OLD WILMOT RD
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City | SCARSDALE
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State | NY
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Zip | 10583-6162
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Country | US
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Telephone | 914-472-5937
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 181822
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License Number State | NY
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