Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | X007048-1 | NY |
NPI | 1124184387 |
---|---|
Provider Name | Dr. Ronald Spinelle |
First Address | Lake Grove, NY 11755-2205 |
Second Address | Selden, NY 11784-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CO7048 | WORKER'S COMPENSATION (01) | NY |
U78349 | (02) | NY |