Provider Demographics
NPI:1295240091
Name:SPOLLEN, MARTIN FRANCIS
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:FRANCIS
Last Name:SPOLLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1123
Mailing Address - Country:US
Mailing Address - Phone:212-234-5211
Mailing Address - Fax:
Practice Address - Street 1:852 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1123
Practice Address - Country:US
Practice Address - Phone:212-234-5211
Practice Address - Fax:917-627-5930
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist