Provider Demographics
NPI:1174199681
Name:SPARTAN MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:SPARTAN MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUVARAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-407-7518
Mailing Address - Street 1:411 PORTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1165
Mailing Address - Country:US
Mailing Address - Phone:908-407-7518
Mailing Address - Fax:
Practice Address - Street 1:133 N KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1313
Practice Address - Country:US
Practice Address - Phone:201-307-4810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty