Provider Demographics
NPI:1023193489
Name:ESCALERA, ELSA (MD)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:ESCALERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6601
Mailing Address - Country:US
Mailing Address - Phone:212-769-6313
Mailing Address - Fax:212-769-7825
Practice Address - Street 1:15 W 65TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6601
Practice Address - Country:US
Practice Address - Phone:212-769-6313
Practice Address - Fax:212-769-7825
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYF76519Medicare UPIN
NYW6112Medicare PIN
F76519Medicare UPIN