Provider Demographics
NPI:1558398149
Name:SPERA, ANTHONY P (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:SPERA
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 1:1 E ROE BLVD
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2631
Mailing Address - Country:US
Mailing Address - Phone:631-475-3900
Mailing Address - Fax:631-475-5166
Practice Address - Street 1:1 E ROE BLVD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2631
Practice Address - Country:US
Practice Address - Phone:631-475-3900
Practice Address - Fax:631-475-5166
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178302207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01839770Medicaid
NY01839770Medicaid
NY59H541Medicare ID - Type Unspecified