Provider Demographics
NPI:1124184387
Name:SPINELLE, RONALD (DOC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:SPINELLE
Suffix:
Gender:M
Credentials:DOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LEE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2205
Mailing Address - Country:US
Mailing Address - Phone:631-737-2014
Mailing Address - Fax:
Practice Address - Street 1:636 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2500
Practice Address - Country:US
Practice Address - Phone:631-736-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007048-1111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO7048OtherWORKER'S COMPENSATION
NYU78349Medicare UPIN
NYCO7048OtherWORKER'S COMPENSATION