Provider Demographics
NPI:1235949223
Name:ESCOBAR, EDWIN (PA-C)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WASHINGTON AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3625
Mailing Address - Country:US
Mailing Address - Phone:201-233-3090
Mailing Address - Fax:
Practice Address - Street 1:45 WASHINGTON AVE APT 8
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3625
Practice Address - Country:US
Practice Address - Phone:201-233-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant