Individual provider Active NPI

Paige E Spagna, DO

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1104447671
Registry record updated May 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
330398-01 Issued in NY
Practice address
14 E 4TH St RM 406
New York, NY 10012-1141
Phone
(212) 918-5011
Fax
(212) 918-5011
NPI assigned
May 6, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 330398-01 NY Primary

Addresses

Primary practice location

14 E 4TH St RM 406
New York, NY 10012-1141

Mailing address

14 E 4TH St RM 406
New York, NY 10012-1141
Phone (212) 918-5011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240930003976 NY Practitioner - Dermatology 4284055070 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Nova Southeastern College of Osteo Medicine, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

10740 Queens Blvd
Suite 204
Forest Hills, NY 11375-4201

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision12
Removal of skin lesions700
Removal of skin cancer1-10
Removal or shaving of skin growth1-10
Skin biopsy295

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
330398-01NYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mariwalla Dermatology, PLLC Single Specialty CurrentSince Oct 1, 2024 Accepting new patients
Dr Anna Karp, LLC Single Specialty Past Accepting new patients
SRP Medical PLLC Dermatology Past Accepting new patients

Locations

1253 Montauk Hwy
West Islip, NY 11795
Phone (631) 661-1400

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780012800000",
    "number": "1104447671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 E 4TH ST RM 406",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100121141",
            "telephone_number": "212-918-5011",
            "fax_number": "212-918-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 E 4TH ST RM 406",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100121141",
            "telephone_number": "212-918-5011",
            "fax_number": "212-918-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPAGNA",
        "first_name": "PAIGE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-06",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "330398-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.