Provider Demographics
NPI:1053498196
Name:SPITZER, MARGO F (MD)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:F
Last Name:SPITZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1828
Mailing Address - Country:US
Mailing Address - Phone:516-239-1641
Mailing Address - Fax:516-239-7499
Practice Address - Street 1:14 MEADOW LN
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1828
Practice Address - Country:US
Practice Address - Phone:516-239-1641
Practice Address - Fax:516-239-7499
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00881021Medicaid
NY36D881Medicare ID - Type Unspecified
NYA62505Medicare UPIN