Provider Demographics
NPI:1639406242
Name:THE HEALTH SPOT FAMILY HEALTH NP/RN, PC
Entity Type:Organization
Organization Name:THE HEALTH SPOT FAMILY HEALTH NP/RN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMALA
Authorized Official - Middle Name:MIYAKO
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPA, MS, FNP/RN
Authorized Official - Phone:585-576-7092
Mailing Address - Street 1:PO BOX 31724
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14603-1724
Mailing Address - Country:US
Mailing Address - Phone:585-622-4380
Mailing Address - Fax:
Practice Address - Street 1:201 DAKOTA ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-1335
Practice Address - Country:US
Practice Address - Phone:585-622-4380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY515251-1251J00000X
NYF335068-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140632Medicaid