Provider Demographics
NPI:1891983839
Name:MARIO SPAGNUOLO MDPC
Entity Type:Organization
Organization Name:MARIO SPAGNUOLO MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAGNUOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:014-968-5574
Mailing Address - Street 1:944 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1304
Mailing Address - Country:US
Mailing Address - Phone:914-968-5574
Mailing Address - Fax:914-968-5612
Practice Address - Street 1:944 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1304
Practice Address - Country:US
Practice Address - Phone:914-968-5574
Practice Address - Fax:914-968-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00131186Medicaid
NY378101Medicare PIN
NYB14054Medicare UPIN