Provider Demographics
NPI:1760472468
Name:SPIELMAN, DENISE (PA)
Entity Type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:
Last Name:SPIELMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2724
Mailing Address - Country:US
Mailing Address - Phone:631-727-7773
Mailing Address - Fax:631-727-7832
Practice Address - Street 1:951 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2724
Practice Address - Country:US
Practice Address - Phone:631-727-7773
Practice Address - Fax:631-727-7832
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010558363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ46954Medicare UPIN
NY5875L1Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER