Provider Demographics
NPI:1306819438
Name:SPITZER, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SPITZER
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 1:14 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:516-355-7802
Mailing Address - Fax:516-467-1387
Practice Address - Street 1:1991 MARCUS AVE
Practice Address - Street 2:SUITE M215
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2057
Practice Address - Country:US
Practice Address - Phone:516-355-7802
Practice Address - Fax:516-467-1387
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY143098207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00776852Medicaid
NYB-80329Medicare UPIN
B80329Medicare UPIN