Provider Demographics
NPI:1679663900
Name:SPATOLIATORE, ROSA L (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:L
Last Name:SPATOLIATORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:731 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1814
Mailing Address - Country:US
Mailing Address - Phone:914-693-5470
Mailing Address - Fax:914-693-5409
Practice Address - Street 1:731 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1814
Practice Address - Country:US
Practice Address - Phone:914-693-5470
Practice Address - Fax:914-693-5409
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY203649208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01693461Medicaid