Provider Demographics
NPI:1114991924
Name:ESCAMILLA, GLORIA M (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:M
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1915
Mailing Address - Country:US
Mailing Address - Phone:631-499-8181
Mailing Address - Fax:631-499-6863
Practice Address - Street 1:180 E PULASKI RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1915
Practice Address - Country:US
Practice Address - Phone:631-499-8181
Practice Address - Fax:631-499-6863
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197325174400000X, 207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3C1752OtherHEALTHNET/PHS
NY467D11OtherBLUE CROSS BLUE SHIELD
NY5140114OtherAETNA
NY160054762OtherRAILROAD MEDICARE
NY219878POtherGREAT WEST ONE HEALTH PLA
NY01613143Medicaid
NY0216038002OtherCIGNA
NY197325A28OtherHEALTH FIRST
NYP60054639OtherMULTIPLAN
NY1409984OtherUNITED HEALTHCARE
NYP391715OtherOXFORD
NY197325OtherHIP
NY9516359OtherGHI
NYP391715OtherOXFORD
NY467D11OtherBLUE CROSS BLUE SHIELD