Provider Demographics
NPI:1407173578
Name:ESCOLA, GARY SEAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:SEAN
Last Name:ESCOLA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:ESCOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:51 W 86TH ST APT 1004
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3743
Mailing Address - Country:US
Mailing Address - Phone:917-587-4371
Mailing Address - Fax:
Practice Address - Street 1:51 W 86TH ST APT 1004
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3743
Practice Address - Country:US
Practice Address - Phone:917-587-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2619082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry