Healthcare Provider Details

I. General information

NPI: 1801602834
Provider Name (Legal Business Name): MARC ESPOSITO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8454 RADNOR ST
JAMAICA NY
11432-2324
US

IV. Provider business mailing address

8454 RADNOR ST
JAMAICA NY
11432-2324
US

V. Phone/Fax

Practice location:
  • Phone: 718-523-2729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125413-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: