Provider Demographics
NPI:1669641718
Name:DARA J SPERBER, DPM
Entity Type:Organization
Organization Name:DARA J SPERBER, DPM
Other - Org Name:ELMORA PODIATRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPERBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-352-3309
Mailing Address - Street 1:127 ELMORA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1692
Mailing Address - Country:US
Mailing Address - Phone:908-352-3309
Mailing Address - Fax:908-352-7961
Practice Address - Street 1:127 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1692
Practice Address - Country:US
Practice Address - Phone:908-352-3309
Practice Address - Fax:908-352-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00199900332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1057940001Medicare NSC