Provider Demographics
NPI:1114408887
Name:ESPOSITO, CHRISTINE DANIELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:DANIELLE
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:DANIELLE
Other - Last Name:KIERNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741
Mailing Address - Country:US
Mailing Address - Phone:516-690-0342
Mailing Address - Fax:631-585-6362
Practice Address - Street 1:203 UNION AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741
Practice Address - Country:US
Practice Address - Phone:516-690-0342
Practice Address - Fax:631-585-6362
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0225051363AM0700X
NY022505363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical