Provider Demographics
NPI:1235326091
Name:SPITALNIK, JASON
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:SPITALNIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:SPITALNIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:15 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1801
Mailing Address - Country:US
Mailing Address - Phone:401-714-6111
Mailing Address - Fax:
Practice Address - Street 1:28 NOOSENECK HILL RD
Practice Address - Street 2:UNIT 3
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-1568
Practice Address - Country:US
Practice Address - Phone:401-385-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT01182174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist