Provider Demographics
NPI:1033190855
Name:ESCUDERO, LEYLA C
Entity Type:Individual
Prefix:MRS
First Name:LEYLA
Middle Name:C
Last Name:ESCUDERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37-10 76TH ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-458-0361
Mailing Address - Fax:
Practice Address - Street 1:40-33 76TH ST
Practice Address - Street 2:SUITE NO 4D
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-458-7426
Practice Address - Fax:718-672-5591
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9177351OtherDORAL
NY01239261Medicaid
NY02303OtherGUARDIAN