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General NPI Number Information
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NPI Number | 1467057935
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Entity Type | Individual
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Provider Name | THERESA C ESPOSITO PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 136 N WASHINGTON AVE STE 203
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City | BERGENFIELD
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State | NJ
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Zip | 07621-1776
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Country | US
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Telephone | 201-374-1718
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Fax |
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Provider Business Mailing Address
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Address Line | 56 WALNUT AVE
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City | BELLMAWR
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State | NJ
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Zip | 08031-2222
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Country | US
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Telephone | 201-290-1954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00589300
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License Number State | NJ
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