Provider Demographics
NPI:1588634380
Name:COLETTE SPACCAVENTO, MD,PC
Entity Type:Organization
Organization Name:COLETTE SPACCAVENTO, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPACCAVENTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-583-2850
Mailing Address - Street 1:110 E 59TH ST
Mailing Address - Street 2:SUITE 9C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1304
Mailing Address - Country:US
Mailing Address - Phone:212-583-2850
Mailing Address - Fax:212-644-8666
Practice Address - Street 1:110 E 59TH ST
Practice Address - Street 2:SUITE 9C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1304
Practice Address - Country:US
Practice Address - Phone:212-583-2850
Practice Address - Fax:212-644-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145008207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEU331Medicare ID - Type Unspecified