Healthcare Provider Details

I. General information

NPI: 1568891547
Provider Name (Legal Business Name): KRISTEN NICOLE ESPOSITO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN NICOLE MORAN P.A.

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 TECHNOLOGY DR SUITE 11
EAST SETAUKET NY
11733-3472
US

IV. Provider business mailing address

STONY BROOK UNIVERSITY HOSPITAL DEPARTMENT OF ORTHOPAEDICS H.S.C T-18, RM 020
STONY BROOK NY
11794
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4233
  • Fax: 631-444-7671
Mailing address:
  • Phone: 631-444-7670
  • Fax: 631-444-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number017097
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: