Healthcare Provider Details

I. General information

NPI: 1194763177
Provider Name (Legal Business Name): MITCHELL K SPINNELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MITCHELL K SPINNELL MD

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SYLVAN AVE STE 101A
ENGLEWOOD CLIFFS NJ
07632-2514
US

IV. Provider business mailing address

140 SYLVAN AVE STE 101A
ENGLEWOOD CLIFFS NJ
07632-2514
US

V. Phone/Fax

Practice location:
  • Phone: 201-945-6564
  • Fax: 201-461-9038
Mailing address:
  • Phone: 201-945-6564
  • Fax: 201-461-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA06936400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: