Basic Information
| Provider Information | |||||||||
| NPI: | 1568629814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPINELLI | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44-01 FRANCIS LEWIS BOULEVARD | ||||||||
| Address2: | SUITE L3A | ||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113613002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187170238 | ||||||||
| FaxNumber: | 7187170265 | ||||||||
| Practice Location | |||||||||
| Address1: | 1155 NORTHERN BLVD | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | MANHASSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110303040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162675708 | ||||||||
| FaxNumber: | 5162675730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 256076 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 03222988 | 05 | NY | MEDICAID |