MEDICARE: LIAM JOHNATHAN SPOLLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		NY

General Provider Information

NPI Number	:	1437089893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIAM JOHNATHAN SPOLLEN

Provider Business Mailing Address
First Line	:	401 ROCKHILL RD
Second Line	:
City	:	VOORHEESVILLE
State	:	NY
Zip	:	12186-4413
Country	:	US
Telephone Number	:	518-545-1966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 NOTT ST
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12308-2489
Country	:	US
Telephone Number	:	518-243-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “ LIAM JOHNATHAN SPOLLEN ” Practice Location

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