1710942073 NPI number — LISA BETH SPOSATO RPA-C

Table of content: LISA BETH SPOSATO RPA-C (NPI 1710942073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710942073 NPI number — LISA BETH SPOSATO RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPOSATO
Provider First Name:
LISA
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
F

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:
1710942073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 BREWSTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SALONGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11768-2616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-807-4802
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 SUNNYSIDE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-982-8594
Provider Business Practice Location Address Fax Number:
888-920-1525
Provider Enumeration Date:
04/19/2006

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: 363AM0700X , with the licence number:  011040 , 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: 03875183 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com