Healthcare Provider Details

I. General information

NPI: 1376782185
Provider Name (Legal Business Name): STACEY ESPOSITO MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 NORTH MAIN STREET FREEPORT COMMUNITY HEALTH CENTER
FREEPORT NY
11520
US

IV. Provider business mailing address

460 NORTH MAIN STREET FREEPORT COMMUNITY HEALTH CENTER
FREEPORT NY
11520
US

V. Phone/Fax

Practice location:
  • Phone: 516-571-8600
  • Fax: 516-571-8622
Mailing address:
  • Phone: 516-571-8600
  • Fax: 516-571-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: