Provider Demographics
NPI:1982455663
Name:SPANO, PAUL SALVATORE (MA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SALVATORE
Last Name:SPANO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BUTTERCUP LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3006
Mailing Address - Country:US
Mailing Address - Phone:631-235-7573
Mailing Address - Fax:
Practice Address - Street 1:3 COLUMBUS CIR STE 1425
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-8720
Practice Address - Country:US
Practice Address - Phone:212-342-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program