Healthcare Provider Details

I. General information

NPI: 1477979433
Provider Name (Legal Business Name): LOUIS SPAGNOLA FAMILY HEALTH NP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 ROUTE 55 SUITE 4
LAGRANGEVILLE NY
12540-5042
US

IV. Provider business mailing address

1145 ROUTE 55 SUITE 4
LAGRANGEVILLE NY
12540-5042
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-5200
  • Fax:
Mailing address:
  • Phone: 845-452-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337825
License Number StateNY

VIII. Authorized Official

Name: DR. LOUIS SPAGNOLA
Title or Position: FAMILY NURSE PRACTIONER
Credential: FNP-C
Phone: 845-452-5200