Provider Demographics
NPI:1508043514
Name:SPERO E DEMOLEAS
Entity Type:Organization
Organization Name:SPERO E DEMOLEAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPERO
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEMOLEAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-930-9090
Mailing Address - Street 1:215 OLD TAPPAN RD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7000
Mailing Address - Country:US
Mailing Address - Phone:201-930-9090
Mailing Address - Fax:201-930-1823
Practice Address - Street 1:215 OLD TAPPAN RD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7000
Practice Address - Country:US
Practice Address - Phone:201-930-9090
Practice Address - Fax:201-930-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01964213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0700050001Medicare NSC