Provider Demographics
NPI:1770469009
Name:SPAGNOLA, RICHARD WILLIAM
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WILLIAM
Last Name:SPAGNOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WARD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2216
Mailing Address - Country:US
Mailing Address - Phone:347-695-7704
Mailing Address - Fax:347-695-7704
Practice Address - Street 1:255 15TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4988
Practice Address - Country:US
Practice Address - Phone:718-788-5101
Practice Address - Fax:718-788-5102
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPENDING363LP0808X
NY787159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health