Provider Demographics
NPI:1073719597
Name:ADRIENNE SPROUSE MD LLC
Entity Type:Organization
Organization Name:ADRIENNE SPROUSE MD LLC
Other - Org Name:MANHATTAN HEALTH CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:BUFFALOE
Authorized Official - Last Name:SPROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-725-5744
Mailing Address - Street 1:31 E 31ST ST
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6829
Mailing Address - Country:US
Mailing Address - Phone:212-725-5744
Mailing Address - Fax:646-649-2461
Practice Address - Street 1:31 EAST 31ST STREET
Practice Address - Street 2:SUITE 4D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-725-5744
Practice Address - Fax:646-649-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1840931207Q00000X, 2083P0500X, 2083T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F32088Medicare UPIN