=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710219787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORIN AMANDA ESKIN P.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2010
-----------------------------------------------------
Last Update Date | 01/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 BANK ST APT 4W
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10014-5226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-304-7575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3959 BROADWAY # CHN723
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-3000
-----------------------------------------------------
Fax | 212-342-2996
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 013481
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------