Individual
MR. BRANDON MARTIN SPAHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
155 W SUNRISE HWY, LINDENHURST, NY 11757-2435
(631) 991-3311
Mailing address
155 W SUNRISE HWY, LINDENHURST, NY 11757-2434
(631) 991-3311
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
029010-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0196271
GHI
NY
01
—
029010
VYTRA
NY
01
—
080723000135
FIDELIS
NY
01
—
11817975
CAQH
NY
Enumeration date
02/16/2007
Last updated
04/07/2015
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