MEDICARE: MR. ERICSON ESPAILLAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1851220487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERICSON ESPAILLAT

Provider Business Mailing Address
First Line	:	965 TINTON AVE APT 7E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-7131
Country	:	US
Telephone Number	:	347-515-4547
Fax Number	:

Provider Business Practice Location Address
First Line	:	248 W 108TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-2956
Country	:	US
Telephone Number	:	212-663-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/19/2026

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Directions to “ MR. ERICSON ESPAILLAT ” Practice Location

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