Provider Demographics
NPI:1003011891
Name:SPIRA, ETAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:ETAN
Middle Name:B
Last Name:SPIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FRANKLIN AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3532
Mailing Address - Country:US
Mailing Address - Phone:973-759-7240
Mailing Address - Fax:973-759-7243
Practice Address - Street 1:5 FRANKLIN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3532
Practice Address - Country:US
Practice Address - Phone:973-759-7240
Practice Address - Fax:973-759-7243
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09471300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0415588Medicaid
NJ3587443UFUMedicare PIN