Provider Demographics
NPI:1619943750
Name:SPERLING, ISABELLA (MD)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:SPERLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-1007
Mailing Address - Country:US
Mailing Address - Phone:631-943-9319
Mailing Address - Fax:631-208-8271
Practice Address - Street 1:632 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2728
Practice Address - Country:US
Practice Address - Phone:631-943-9319
Practice Address - Fax:631-208-8271
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2359861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY326AY1OtherEMPIRE BLUE SHIELD
NY02322012Medicaid
NYP3605393OtherOXFORD
NY326AY1OtherEMPIRE BLUE SHIELD
NYP3605393OtherOXFORD
NYP00252558Medicare ID - Type UnspecifiedRR