=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962368456
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN ESGRO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2025
-----------------------------------------------------
Last Update Date | 12/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 552 N WEBSTER AVE
-----------------------------------------------------
City | SCRANTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18510-2215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-594-6167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 552 N WEBSTER AVE
-----------------------------------------------------
City | SCRANTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18510-2215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | ND6559
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------