Healthcare Provider Details

I. General information

NPI: 1255012894
Provider Name (Legal Business Name): SUSAN ESPINAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 MILL POND WAY
EATONTOWN NJ
07724-2478
US

IV. Provider business mailing address

PO BOX 851
BELMAR NJ
07719-0851
US

V. Phone/Fax

Practice location:
  • Phone: 848-667-3098
  • Fax:
Mailing address:
  • Phone: 732-910-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00633200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: