Healthcare Provider Details

I. General information

NPI: 1528416989
Provider Name (Legal Business Name): CHRISTOPHER JOHN ESPOSITO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 MASON AVE BLDG C3
STATEN ISLAND NY
10305-3408
US

IV. Provider business mailing address

256 MASON AVE BLDG C3
STATEN ISLAND NY
10305-3408
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-1300
  • Fax:
Mailing address:
  • Phone: 718-226-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2021024760
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number316992
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: