Provider Demographics
NPI:1538182720
Name:SPADACCINI, CARMINE (PA)
Entity type:Individual
Prefix:
First Name:CARMINE
Middle Name:
Last Name:SPADACCINI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 STONELEIGH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3990
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4326
Practice Address - Street 1:664 STONELEIGH AVE STE 300
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3990
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4326
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011105363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00316739OtherRAILROAD MEDICARE
NY4682510001Medicare NSC
NY4682510003Medicare NSC
NY4682510004Medicare NSC
NY6214LCJ511Medicare PIN
NYP00316739OtherRAILROAD MEDICARE