Provider Demographics
NPI:1730460700
Name:JOSE A ESCALONA MD PA LLC
Entity Type:Organization
Organization Name:JOSE A ESCALONA MD PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESCALONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-234-1411
Mailing Address - Street 1:115 UNION MILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6299
Mailing Address - Country:US
Mailing Address - Phone:856-234-1411
Mailing Address - Fax:856-234-1412
Practice Address - Street 1:115 UNION MILL RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-6299
Practice Address - Country:US
Practice Address - Phone:856-234-1411
Practice Address - Fax:856-234-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
228691Medicare PIN