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General NPI Number Information
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NPI Number | 1396210050
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Entity Type | Individual
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Provider Name | KATELYN MARIE SPADALIK PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/09/2018
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 2701 QUEENS PLZ N FL 10
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-4022
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Country | US
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Telephone | 516-233-9256
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Fax |
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Provider Business Mailing Address
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Address Line | 260 E MIDDLE COUNTRY RD STE 208
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City | SMITHTOWN
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State | NY
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Zip | 11787-2925
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Country | US
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Telephone | 631-863-3223
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Fax | 631-863-3334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 022466
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License Number State | NY
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