Provider Demographics
NPI:1174640940
Name:ESPOSITO, MARCO JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:JOHN
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 POMPTON RD
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1615
Mailing Address - Country:US
Mailing Address - Phone:973-956-5678
Mailing Address - Fax:
Practice Address - Street 1:115 POMPTON RD
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1615
Practice Address - Country:US
Practice Address - Phone:973-956-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00619300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090558Medicare ID - Type Unspecified