Provider Demographics
NPI:1639573769
Name:VINCENT SPERANDEO NP IN FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:VINCENT SPERANDEO NP IN FAMILY HEALTH PLLC
Other - Org Name:FUSION HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERANDEO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:631-312-2838
Mailing Address - Street 1:1174 ROUTE 112
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8033
Mailing Address - Country:US
Mailing Address - Phone:631-320-7503
Mailing Address - Fax:
Practice Address - Street 1:1174 ROUTE 112
Practice Address - Street 2:SUITE C
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-8033
Practice Address - Country:US
Practice Address - Phone:631-320-7503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty