Healthcare Provider Details

I. General information

NPI: 1124184387
Provider Name (Legal Business Name): RONALD SPINELLE DOC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 MIDDLE COUNTRY RD
SELDEN NY
11784-2500
US

IV. Provider business mailing address

5 LEE CT
LAKE GROVE NY
11755-2205
US

V. Phone/Fax

Practice location:
  • Phone: 631-736-4414
  • Fax:
Mailing address:
  • Phone: 631-737-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberX007048-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: