Provider Demographics
NPI:1114355609
Name:SPITZER, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SPITZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 FORESTBURGH RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-2312
Mailing Address - Country:US
Mailing Address - Phone:845-436-5747
Mailing Address - Fax:
Practice Address - Street 1:70 FORESTBURGH RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2312
Practice Address - Country:US
Practice Address - Phone:845-436-5747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03397853172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver