Healthcare Provider Details

I. General information

NPI: 1639409782
Provider Name (Legal Business Name): GAETANO G SPINNATO DMD MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BROADWAY
BAYONNE NJ
07002
US

IV. Provider business mailing address

925 BROADWAY
BAYONNE NJ
07002
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-1400
  • Fax: 201-858-0503
Mailing address:
  • Phone: 201-858-1400
  • Fax: 201-858-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8521
License Number StateNJ

VIII. Authorized Official

Name: DR. GAETANO G SPINNATO
Title or Position: OWNER
Credential: DMD MD LLC
Phone: 201-858-1400