Healthcare Provider Details

I. General information

NPI: 1215956982
Provider Name (Legal Business Name): MARIA C ESPIRITU-FULLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA C ESPIRITU M.D.

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

201 LYONS AVE
NEWARK NJ
07112-2027
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-7000
  • Fax: 973-926-6186
Mailing address:
  • Phone: 973-926-7000
  • Fax: 973-926-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMA45301
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: