Provider Demographics
NPI:1801843859
Name:ESQUENAZI, ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:ESQUENAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2220
Mailing Address - Country:US
Mailing Address - Phone:215-663-6600
Mailing Address - Fax:215-456-9491
Practice Address - Street 1:101 E OLNEY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2421
Practice Address - Country:US
Practice Address - Phone:215-456-7000
Practice Address - Fax:215-254-2599
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035480L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA164092Medicare ID - Type Unspecified
PAC32512Medicare UPIN