Provider Demographics
NPI:1376555847
Name:SPINELLI, NANCY ANN (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:SPINELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 OWEN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3629
Mailing Address - Country:US
Mailing Address - Phone:201-475-5750
Mailing Address - Fax:973-625-7484
Practice Address - Street 1:35 W MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2174
Practice Address - Country:US
Practice Address - Phone:973-627-9635
Practice Address - Fax:973-625-7484
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB072247207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067458Medicare ID - Type UnspecifiedLPIN
NJH78825Medicare UPIN