MEDICARE: NANCY ANN SPINELLI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MB072247	NJ

General Provider Information

NPI Number	:	1376555847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ANN SPINELLI D.O.

Provider Business Mailing Address
First Line	:	385 OWEN AVE
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-3629
Country	:	US
Telephone Number	:	201-475-5750
Fax Number	:	973-625-7484

Provider Business Practice Location Address
First Line	:	35 W MAIN ST
Second Line	:	SUITE 201
City	:	DENVILLE
State	:	NJ
Zip	:	07834-2174
Country	:	US
Telephone Number	:	973-627-9635
Fax Number	:	973-625-7484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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