MEDICARE: JESSICA ESCALANTE PA

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	363AM0700X	Medical Physician Assistant	015241	NY

General Provider Information

NPI Number	:	1144506338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ESCALANTE PA

Provider Business Mailing Address
First Line	:	4046 75TH ST
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4046 75TH ST
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1012
Country	:	US
Telephone Number	:	718-335-7437
Fax Number	:

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

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/01/2011

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Directions to “ JESSICA ESCALANTE PA” Practice Location

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