MEDICARE: DR. MARY JEAN SPINELLI MD

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	207V00000X	Obstetrics & Gynecology Physician	158974	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0202911	OTHER		GHI

General Provider Information

NPI Number	:	1871623363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JEAN SPINELLI MD

Provider Business Mailing Address
First Line	:	1032 FOREST HILL ROAD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314
Country	:	US
Telephone Number	:	718-981-0300
Fax Number	:	718-815-3961

Provider Business Practice Location Address
First Line	:	1023 FOREST HILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6323
Country	:	US
Telephone Number	:	718-981-0300
Fax Number	:	718-815-3961

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	06/29/2009

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