Healthcare Provider Details

I. General information

NPI: 1528496692
Provider Name (Legal Business Name): JEFFREY ROBERT ESPINOZA D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8802 107TH AVE
OZONE PARK NY
11417-1345
US

IV. Provider business mailing address

88-02 107TH AVE
OZONE PARK NY
11417
US

V. Phone/Fax

Practice location:
  • Phone: 718-541-1693
  • Fax:
Mailing address:
  • Phone: 718-541-1693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number035172-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: