1548510316 NPI number — MS. MARY ANNE ESPOSITO PHYSICAL THERAPIST

Table of content: MS. MARY ANNE ESPOSITO PHYSICAL THERAPIST (NPI 1548510316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548510316 NPI number — MS. MARY ANNE ESPOSITO PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESPOSITO
Provider First Name:
MARY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548510316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 MONTAUK HWY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
WEST ISLIP
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11795-4429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-661-3700
Provider Business Mailing Address Fax Number:
631-661-3749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MONTAUK HWY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WEST ISLIP
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11795-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-661-3700
Provider Business Practice Location Address Fax Number:
631-661-3749
Provider Enumeration Date:
09/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  035550 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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