Provider Demographics
NPI:1245259696
Name:SPELLMAN, JAMES G (APN)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:SPELLMAN
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2437
Mailing Address - Country:US
Mailing Address - Phone:917-608-9775
Mailing Address - Fax:
Practice Address - Street 1:24 LINDEN ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2437
Practice Address - Country:US
Practice Address - Phone:917-608-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN97049363LF0000X
NY332561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P14007Medicare UPIN
042362Medicare ID - Type Unspecified