Healthcare Provider Details

I. General information

NPI: 1760472468
Provider Name (Legal Business Name): DENISE SPIELMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 ROANOKE AVE
RIVERHEAD NY
11901-2724
US

IV. Provider business mailing address

951 ROANOKE AVE
RIVERHEAD NY
11901-2724
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-7773
  • Fax: 631-727-7832
Mailing address:
  • Phone: 631-727-7773
  • Fax: 631-727-7832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number010558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: