Provider Demographics
NPI:1467616052
Name:SPRUNG, CHARLES L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:SPRUNG
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:MEVO BENIN 30
Mailing Address - Street 2:
Mailing Address - City:JERUSALEM
Mailing Address - State:ISRAEL
Mailing Address - Zip Code:91120
Mailing Address - Country:IL
Mailing Address - Phone:9722-566-5948
Mailing Address - Fax:9722-567-1413
Practice Address - Street 1:12 N STAR RD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2306
Practice Address - Country:US
Practice Address - Phone:201-768-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33069207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine