Provider Demographics
NPI:1992978654
Name:ESCOBAR, GLORIA S (MD)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:S
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:148 ISLIP AVENUE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751
Mailing Address - Country:US
Mailing Address - Phone:631-650-6580
Mailing Address - Fax:631-650-6578
Practice Address - Street 1:148 ISLIP AVENUE
Practice Address - Street 2:SUITE 27
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751
Practice Address - Country:US
Practice Address - Phone:631-650-6580
Practice Address - Fax:631-650-6578
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY249522207Q00000X
NY249544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY297185702OtherUNITED HEALTH CARE
NY754858POtherHIP
NY8865361001OtherCIGNA
NY8891P2OtherEMPIRE BLUE CROSS BLUE SHIELD
NYP4028576OtherOXFORD
NY8515062OtherMULTIPLAN
NY03113155Medicaid
NY1238845OtherGHI
NY9524277OtherAETNA
NYA400014743Medicare PIN