Provider Demographics
NPI:1437258985
Name:ESCOBAR, HERMANN (DO)
Entity Type:Individual
Prefix:
First Name:HERMANN
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2765
Mailing Address - Country:US
Mailing Address - Phone:718-204-2200
Mailing Address - Fax:718-204-2218
Practice Address - Street 1:2318 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2765
Practice Address - Country:US
Practice Address - Phone:718-204-2200
Practice Address - Fax:718-204-2218
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221341-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100000422Medicare PIN
NY400003063Medicare PIN
NY38V231Medicare PIN
NY8149DHMedicare PIN
NYH51169Medicare UPIN