Provider Demographics
NPI:1558364505
Name:SPINAK, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SPINAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 N MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2029
Mailing Address - Country:US
Mailing Address - Phone:845-735-5666
Mailing Address - Fax:845-735-5673
Practice Address - Street 1:169 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2029
Practice Address - Country:US
Practice Address - Phone:845-735-5666
Practice Address - Fax:845-735-5673
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185039-1174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132998987OtherTAX ID
NY01516590Medicaid
NY180017200OtherPALMETTO GBA RAILROAD MEDICARE
NY180017200Medicare PIN
NY01516590Medicaid
NY180017200OtherPALMETTO GBA RAILROAD MEDICARE
NYF26431Medicare UPIN