Healthcare Provider Details

I. General information

NPI: 1467326454
Provider Name (Legal Business Name): JOSEPH JOHN SPINA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR STE 210B
PLAINVIEW NY
11803-1711
US

IV. Provider business mailing address

107 UNDERHILL ST
YONKERS NY
10710-3715
US

V. Phone/Fax

Practice location:
  • Phone: 516-687-9563
  • Fax:
Mailing address:
  • Phone: 516-687-9563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF356339-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: