Individual
GUILLERMO STEVEN ESCOBAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 632-6000
Mailing address
38 SUFFOLK AVE, PATCHOGUE, NY 11772-1652
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDKSC7325736
BLUE CROSS BLUE SHIELD
NY
Enumeration date
03/04/2019
Last updated
03/04/2019
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