Provider Demographics
NPI:1952741902
Name:ESCOBAR-BELTRAN, MAGDA JULISSA (NP)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:JULISSA
Last Name:ESCOBAR-BELTRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAGDA
Other - Middle Name:JULISSA
Other - Last Name:ESCOBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:81 GRATTAN ST
Mailing Address - Street 2:APT 1R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-1979
Mailing Address - Country:US
Mailing Address - Phone:917-304-9021
Mailing Address - Fax:
Practice Address - Street 1:160 W 26TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6975
Practice Address - Country:US
Practice Address - Phone:212-924-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-04
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily