Individual
JORGE MANUEL REVELO ESCOBAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 334-2156
Mailing address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 334-2156
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
316622-01
NY
Other
Enumeration date
07/24/2018
Last updated
07/22/2022
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