Provider Demographics
NPI:1609805720
Name:ESPOCIA, PAUL GERARD (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GERARD
Last Name:ESPOCIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 69TH RD
Mailing Address - Street 2:#FL2
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6611
Mailing Address - Country:US
Mailing Address - Phone:917-445-5916
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:20 PEACHTREE CT
Practice Address - Street 2:STE 105
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4616
Practice Address - Country:US
Practice Address - Phone:631-467-3700
Practice Address - Fax:631-467-0928
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022601-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist