Healthcare Provider Details

I. General information

NPI: 1578574935
Provider Name (Legal Business Name): DEAN SPELLMAN D. P. M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3594 E TREMONT AVE
BRONX NY
10465-2032
US

IV. Provider business mailing address

13 DEERFOOT LANE
YONKERS NY
10710-2325
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-5511
  • Fax: 718-863-0246
Mailing address:
  • Phone: 718-863-5511
  • Fax: 718-863-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN002994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: