Healthcare Provider Details

I. General information

NPI: 1710492723
Provider Name (Legal Business Name): MARIA J SPINOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 ATLANTIC AVE
BALDWIN NY
11510-4063
US

IV. Provider business mailing address

961 BRUCE DR
WANTAGH NY
11793-1115
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-2221
  • Fax:
Mailing address:
  • Phone: 516-996-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number547922-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: