Provider Demographics
NPI:1811704513
Name:ESCOURSE, MARTIN FAQUAN SR
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:FAQUAN
Last Name:ESCOURSE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 ASTORIA PL
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4208
Mailing Address - Country:US
Mailing Address - Phone:732-231-5273
Mailing Address - Fax:732-860-9883
Practice Address - Street 1:35 OBRIEN ST UNIT E7
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-4212
Practice Address - Country:US
Practice Address - Phone:732-231-5273
Practice Address - Fax:732-860-9883
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor