Healthcare Provider Details

I. General information

NPI: 1548510316
Provider Name (Legal Business Name): MARY ANNE ESPOSITO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MONTAUK HWY SUITE 103
WEST ISLIP NY
11795-4429
US

IV. Provider business mailing address

400 MONTAUK HWY SUITE 103
WEST ISLIP NY
11795-4429
US

V. Phone/Fax

Practice location:
  • Phone: 631-661-3700
  • Fax: 631-661-3749
Mailing address:
  • Phone: 631-661-3700
  • Fax: 631-661-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number035550
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: