Provider Demographics
NPI:1669579629
Name:SPAGNOLA, LOUIS J (FNP-C)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:J
Last Name:SPAGNOLA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 ROUTE 55
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5042
Mailing Address - Country:US
Mailing Address - Phone:845-452-5200
Mailing Address - Fax:845-483-0824
Practice Address - Street 1:1145 ROUTE 55
Practice Address - Street 2:SUITE 4
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5042
Practice Address - Country:US
Practice Address - Phone:845-452-5200
Practice Address - Fax:845-483-0824
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005054-1111N00000X
CT005270363LF0000X
NYF337825-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004141313Medicaid
CT004141313Medicaid
CT350000660Medicare UPIN