Provider Demographics
NPI:1326094053
Name:SAPERSTEIN, GARY STEPHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEPHAN
Last Name:SAPERSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3539 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1803
Mailing Address - Country:US
Mailing Address - Phone:718-543-4400
Mailing Address - Fax:718-543-4401
Practice Address - Street 1:3539 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1803
Practice Address - Country:US
Practice Address - Phone:718-543-4400
Practice Address - Fax:718-543-4401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0003787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT48994Medicare UPIN
NYC31491Medicare ID - Type Unspecified