Provider Demographics
NPI:1407137474
Name:EUBANK SPAGNOLETTI, MICHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:EUBANK SPAGNOLETTI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NORTHERN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 NORTHERN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4027
Practice Address - Country:US
Practice Address - Phone:516-466-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004073171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist