Provider Demographics
NPI:1043209729
Name:NUEVA ESPANA, ERNESTO AQUIATAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:AQUIATAN
Last Name:NUEVA ESPANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 OLD WILMOT RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6162
Mailing Address - Country:US
Mailing Address - Phone:914-472-5937
Mailing Address - Fax:
Practice Address - Street 1:5401 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10471-1214
Practice Address - Country:US
Practice Address - Phone:718-581-1200
Practice Address - Fax:718-581-1012
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F75818Medicare UPIN
NY731251Medicare PIN
73I251Medicare ID - Type Unspecified