Healthcare Provider Details

I. General information

NPI: 1538182720
Provider Name (Legal Business Name): CARMINE SPADACCINI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 STONELEIGH AVE STE 300
CARMEL NY
10512-3990
US

IV. Provider business mailing address

664 STONELEIGH AVE STE 300
CARMEL NY
10512-3990
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-8400
  • Fax: 845-278-4326
Mailing address:
  • Phone: 845-278-8400
  • Fax: 845-278-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: