Healthcare Provider Details

I. General information

NPI: 1639517923
Provider Name (Legal Business Name): KATHLEEN SPIESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 JERUSALEM AVE SUITE 106
NORTH BELLMORE NY
11710-1870
US

IV. Provider business mailing address

2415 JERUSALEM AVE SUITE 106
NORTH BELLMORE NY
11710-1870
US

V. Phone/Fax

Practice location:
  • Phone: 516-785-5257
  • Fax: 516-785-5154
Mailing address:
  • Phone: 516-785-5257
  • Fax: 516-785-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: