Provider Demographics
NPI:1316042989
Name:SPIVAK, CARL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JAMES
Last Name:SPIVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MATAWAN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2653
Mailing Address - Country:US
Mailing Address - Phone:732-441-7177
Mailing Address - Fax:732-441-7165
Practice Address - Street 1:157 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1004
Practice Address - Country:US
Practice Address - Phone:908-452-5612
Practice Address - Fax:908-452-5624
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251625207T00000X
NJ25MA09005200207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ244113OtherMEDICARE NJ
NJ0404624Medicaid
NY02941697Medicaid