Provider Demographics
NPI:1407121593
Name:ESCORCIA, FREDDY E (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDDY
Middle Name:E
Last Name:ESCORCIA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 YORK AVE # 362
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6307
Mailing Address - Country:US
Mailing Address - Phone:309-253-5606
Mailing Address - Fax:
Practice Address - Street 1:1230 YORK AVE # 362
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6307
Practice Address - Country:US
Practice Address - Phone:309-253-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program