1669579629 NPI number — MR. LOUIS J. SPAGNOLA FNP-C

Table of content: MR. LOUIS J. SPAGNOLA FNP-C (NPI 1669579629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669579629 NPI number — MR. LOUIS J. SPAGNOLA FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPAGNOLA
Provider First Name:
LOUIS
Provider Middle Name:
J.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1669579629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 ROUTE 55
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
LAGRANGEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12540-5042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-452-5200
Provider Business Mailing Address Fax Number:
845-483-0824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 ROUTE 55
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
LAGRANGEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12540-5042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-452-5200
Provider Business Practice Location Address Fax Number:
845-483-0824
Provider Enumeration Date:
09/20/2006

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: 111N00000X , with the licence number:  X005054-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 005270 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: F337825-1 , 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: 004141313 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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