Healthcare Provider Details

I. General information

NPI: 1790501039
Provider Name (Legal Business Name): ROSEANNE ESPOSITO EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR STE LL105
PLAINVIEW NY
11803-1718
US

IV. Provider business mailing address

11 SALISBURY LN
WARWICK NY
10990-4117
US

V. Phone/Fax

Practice location:
  • Phone: 516-248-7572
  • Fax:
Mailing address:
  • Phone: 845-494-4365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: