Provider Demographics
NPI:1447215983
Name:MELVIN I. SPIELBERG,M.D. P.C.
Entity Type:Organization
Organization Name:MELVIN I. SPIELBERG,M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:SPIELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-627-9423
Mailing Address - Street 1:148 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06016-9605
Mailing Address - Country:US
Mailing Address - Phone:860-627-9423
Mailing Address - Fax:860-623-5226
Practice Address - Street 1:148 NORTH RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06016-9605
Practice Address - Country:US
Practice Address - Phone:860-627-9423
Practice Address - Fax:860-623-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001215847Medicaid
CT001215847Medicaid