Healthcare Provider Details

I. General information

NPI: 1780794081
Provider Name (Legal Business Name): ALBERT C ESPOSITO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OAK ST SUITE #8
PATCHOGUE NY
11772-2841
US

IV. Provider business mailing address

31 OAK ST SUITE #8
PATCHOGUE NY
11772-2841
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-0804
  • Fax: 631-475-0806
Mailing address:
  • Phone: 631-475-0804
  • Fax: 631-475-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number4079-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01470566
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: