Provider Demographics
NPI:1457487357
Name:SPATZ, GEORGE W IV (LPN)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:W
Last Name:SPATZ
Suffix:IV
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043
Mailing Address - Country:US
Mailing Address - Phone:716-681-5358
Mailing Address - Fax:
Practice Address - Street 1:4922 BROADWAY
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-3945
Practice Address - Country:US
Practice Address - Phone:716-681-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123953164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse