Provider Demographics
NPI:1346849437
Name:ESPOSITO, STEPHANIE JOANNE (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOANNE
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TARPON RD
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-4901
Mailing Address - Country:US
Mailing Address - Phone:631-833-1313
Mailing Address - Fax:
Practice Address - Street 1:12 PLATINUM CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2247
Practice Address - Country:US
Practice Address - Phone:631-833-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032377-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist