Provider Demographics
NPI:1689329898
Name:ESKANDAR, NICOLE JOY
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JOY
Last Name:ESKANDAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1720
Mailing Address - Country:US
Mailing Address - Phone:346-489-3109
Mailing Address - Fax:
Practice Address - Street 1:25 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1720
Practice Address - Country:US
Practice Address - Phone:346-489-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
890948040OtherUN SHIP
07975462OtherNYSHIP
890949040OtherNYSHIP