MEDICARE: DR. PAMELA DIANE L. ESCOBAR DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	317358	NY
2	208800000X	Urology Physician	317358	NY

General Provider Information

NPI Number	:	1013404227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA DIANE L. ESCOBAR DO

Provider Business Mailing Address
First Line	:	1441 SOUTH AVE STE 701
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3784
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 SOUTH AVE STE 701
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3784
Country	:	US
Telephone Number	:	718-226-6461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	03/12/2024

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