Provider Demographics
NPI:1306178421
Name:DIEGO ESCOBAR MD, PC
Entity Type:Organization
Organization Name:DIEGO ESCOBAR MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-265-7865
Mailing Address - Street 1:320 E 46TH ST
Mailing Address - Street 2:APT 20-G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-3042
Mailing Address - Country:US
Mailing Address - Phone:646-265-7865
Mailing Address - Fax:201-288-7801
Practice Address - Street 1:320 E 46TH ST
Practice Address - Street 2:APT 20-G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3042
Practice Address - Country:US
Practice Address - Phone:646-265-7865
Practice Address - Fax:201-288-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY236217OtherLICENSE