Provider Demographics
NPI:1639165293
Name:ESPOSITO, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1145
Mailing Address - Country:US
Mailing Address - Phone:718-224-7186
Mailing Address - Fax:718-224-1680
Practice Address - Street 1:2619 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1145
Practice Address - Country:US
Practice Address - Phone:718-224-7186
Practice Address - Fax:718-224-1680
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY178318207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01335157Medicaid
NY01335157Medicaid
NY05639GMedicare ID - Type Unspecified