Provider Demographics
NPI:1770875239
Name:COLPA-SPINELLI, ELIAN
Entity type:Individual
Prefix:
First Name:ELIAN
Middle Name:
Last Name:COLPA-SPINELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EHLER ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6013
Mailing Address - Country:US
Mailing Address - Phone:631-987-9149
Mailing Address - Fax:
Practice Address - Street 1:23 EHLER ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-6013
Practice Address - Country:US
Practice Address - Phone:631-987-9149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305072164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse