1568629814 NPI number — MICHAEL A SPINELLI M.D.

Table of content: MICHAEL A SPINELLI M.D. (NPI 1568629814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568629814 NPI number — MICHAEL A SPINELLI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPINELLI
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568629814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44-01 FRANCIS LEWIS BOULEVARD
Provider Second Line Business Mailing Address:
SUITE L3A
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11361-3002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-717-0238
Provider Business Mailing Address Fax Number:
718-717-0265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1155 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
MANHASSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11030-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-267-5708
Provider Business Practice Location Address Fax Number:
516-267-5730
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X , with the licence number:  256076 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03222988 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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