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NPI Code Detail

MEDICARE: KATELYN MARIE SPADALIK PA-C

MEDICARE: KATELYN MARIE SPADALIK PA-C
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
1363A00000XPhysician Assistant022466NY

General Provider Information

NPI Number : 1396210050
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN MARIE SPADALIK PA-C
Provider Business Mailing Address
First Line : 260 E MIDDLE COUNTRY RD STE 208
Second Line :
City : SMITHTOWN
State : NY
Zip : 11787-2925
Country : US
Telephone Number : 631-863-3223
Fax Number : 631-863-3334
Provider Business Practice Location Address
First Line : 2701 QUEENS PLZ N FL 10
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-4022
Country : US
Telephone Number : 516-233-9256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2018
Last Update Date : 12/11/2020

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