1063561744 NPI number — DAVID E SPERBER MD

Table of content: DAVID E SPERBER MD (NPI 1063561744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063561744 NPI number — DAVID E SPERBER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPERBER
Provider First Name:
DAVID
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063561744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 S JENSEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VESTAL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13850-2821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-770-9000
Provider Business Mailing Address Fax Number:
607-770-1637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 S JENSEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VESTAL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13850-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-770-9000
Provider Business Practice Location Address Fax Number:
607-770-1637
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  177414-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: 177414-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01665392 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1539123 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 180029198 . This is a "UHC RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 989809 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4498545 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10032773 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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