Provider Demographics
NPI:1578574935
Name:SPELLMAN, DEAN (D P M)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:SPELLMAN
Suffix:
Gender:M
Credentials:D P M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DEERFOOT LANE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-2325
Mailing Address - Country:US
Mailing Address - Phone:718-863-5511
Mailing Address - Fax:718-863-0246
Practice Address - Street 1:3594 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2032
Practice Address - Country:US
Practice Address - Phone:718-863-5511
Practice Address - Fax:718-863-0246
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002994213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00405252Medicaid