Healthcare Provider Details

I. General information

NPI: 1114408887
Provider Name (Legal Business Name): CHRISTINE DANIELLE ESPOSITO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE DANIELLE KIERNAN

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 UNION AVE
HOLBROOK NY
11741
US

IV. Provider business mailing address

203 UNION AVE
HOLBROOK NY
11741
US

V. Phone/Fax

Practice location:
  • Phone: 516-690-0342
  • Fax: 631-585-6362
Mailing address:
  • Phone: 516-690-0342
  • Fax: 631-585-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0225051
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number022505
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: