1568891547 NPI number — MRS. KRISTEN NICOLE ESPOSITO P.A.

Table of content: MRS. KRISTEN NICOLE ESPOSITO P.A. (NPI 1568891547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568891547 NPI number — MRS. KRISTEN NICOLE ESPOSITO P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESPOSITO
Provider First Name:
KRISTEN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORAN
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568891547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STONY BROOK UNIVERSITY HOSPITAL
Provider Second Line Business Mailing Address:
DEPARTMENT OF ORTHOPAEDICS H.S.C T-18, RM 020
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-444-7670
Provider Business Mailing Address Fax Number:
631-444-7671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 TECHNOLOGY DR
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
EAST SETAUKET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11733-3472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-4233
Provider Business Practice Location Address Fax Number:
631-444-7671
Provider Enumeration Date:
11/11/2013

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: 363AM0700X , with the licence number:  017097 , 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)

  • Identifier: 04297274 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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