1215299144 NPI number — MARK SPITZER, MD P.C.

Table of content: JOSHUA FRANKLIN GOOCH RN (NPI 1376359976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215299144 NPI number — MARK SPITZER, MD P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK SPITZER, MD P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1215299144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 MEADOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11559-1828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-355-7802
Provider Business Mailing Address Fax Number:
516-467-1387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 MARCUS AVE STE M101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-355-7802
Provider Business Practice Location Address Fax Number:
516-467-1387
Provider Enumeration Date:
06/15/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPITZER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-355-7802

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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