Healthcare Provider Details

I. General information

NPI: 1265352199
Provider Name (Legal Business Name): WILLIAM SPISAK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LIAM SPISAK PA-C

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

10 SHADOW LN
EAST WILLISTON NY
11596-2511
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-0333
  • Fax:
Mailing address:
  • Phone: 516-574-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036094
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: