Provider Demographics
NPI:1568891547
Name:ESPOSITO, KRISTEN NICOLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDICS H.S.C T-18, RM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-444-7670
Mailing Address - Fax:631-444-7671
Practice Address - Street 1:14 TECHNOLOGY DR
Practice Address - Street 2:SUITE 11
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3472
Practice Address - Country:US
Practice Address - Phone:631-444-4233
Practice Address - Fax:631-444-7671
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017097363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04297274Medicaid