Provider Demographics
NPI:1669537932
Name:SPATA, NATALE F (DC)
Entity type:Individual
Prefix:DR
First Name:NATALE
Middle Name:F
Last Name:SPATA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 SOUTHAVEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3746
Mailing Address - Country:US
Mailing Address - Phone:631-758-0333
Mailing Address - Fax:631-758-0334
Practice Address - Street 1:74 SOUTHAVEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3746
Practice Address - Country:US
Practice Address - Phone:631-758-0333
Practice Address - Fax:631-758-0334
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4436OtherLICENSE
NYX4436OtherLICENSE
NYX24491Medicare ID - Type Unspecified