Provider Demographics
NPI:1619603974
Name:CM SPA LLC
Entity Type:Organization
Organization Name:CM SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONCETTA
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:MANGIARACINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-659-1913
Mailing Address - Street 1:1955 MERRICK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4615
Mailing Address - Country:US
Mailing Address - Phone:516-659-1913
Mailing Address - Fax:
Practice Address - Street 1:1955 MERRICK RD STE 101
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4615
Practice Address - Country:US
Practice Address - Phone:516-659-1913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1265661102OtherINDIVIDUAL NPI