Provider Demographics
NPI:1265425144
Name:SPINA, JOHN H (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:SPINA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4609
Mailing Address - Country:US
Mailing Address - Phone:718-596-9567
Mailing Address - Fax:
Practice Address - Street 1:153 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3108
Practice Address - Country:US
Practice Address - Phone:718-230-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004971213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01296386Medicaid
NY01296386Medicaid
NYP55411Medicare ID - Type Unspecified