Healthcare Provider Details

I. General information

NPI: 1063316446
Provider Name (Legal Business Name): DAMON SPAGNOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CARLISLE RD
TOMS RIVER NJ
08757-5603
US

IV. Provider business mailing address

99 NJ-37
TOMS RIVER NJ
08755
US

V. Phone/Fax

Practice location:
  • Phone: 848-226-7245
  • Fax:
Mailing address:
  • Phone: 732-403-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: