Healthcare Provider Details

I. General information

NPI: 1528676558
Provider Name (Legal Business Name): JOHN ESPOSITO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9324 QUEENS BLVD APT 5N
REGO PARK NY
11374-1110
US

IV. Provider business mailing address

9324 QUEENS BLVD APT 5N
REGO PARK NY
11374-1110
US

V. Phone/Fax

Practice location:
  • Phone: 917-225-1577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: