Healthcare Provider Details

I. General information

NPI: 1174903983
Provider Name (Legal Business Name): PATRICIA ESPOSITO RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2015
Last Update Date: 06/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NAMKEE LN
BLUE POINT NY
11715-2212
US

IV. Provider business mailing address

12 NAMKEE LN
BLUE POINT NY
11715-2212
US

V. Phone/Fax

Practice location:
  • Phone: 631-363-0424
  • Fax:
Mailing address:
  • Phone: 631-363-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number183506-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: