Healthcare Provider Details

I. General information

NPI: 1427536416
Provider Name (Legal Business Name): MICHAEL ANTHONY ESPOSITO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD STE 125
COLORADO SPRINGS CO
80910-3117
US

IV. Provider business mailing address

121 STRATTFORD RD
NEW HYDE PARK NY
11040-3535
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-1950
  • Fax: 719-365-1951
Mailing address:
  • Phone: 516-780-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number022414
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0006122
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: