MEDICARE: ELIZABETH ESPOSITO MS, LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AL 1898	FL
2	2255A2300X	Athletic Trainer	25MT00136800	NJ

General Provider Information

NPI Number	:	1629099452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ESPOSITO MS, LAT, ATC

Provider Business Mailing Address
First Line	:	1932 RUTHERFORD ST
Second Line	:
City	:	RAHWAY
State	:	NJ
Zip	:	07065-5305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 MORRIS AVE STE 1
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-7131
Country	:	US
Telephone Number	:	908-737-0661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/18/2020

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