Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X005506 | NY |
NPI | 1942393368 |
---|---|
Provider Name | Dr. John Joseph Spano |
First Address | Brentwood, NY 11717-4518 |
Second Address | Brentwood, NY 11717-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 08/07/2007 |