Provider Demographics
NPI:1861469595
Name:SPITZ, GARY F (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:F
Last Name:SPITZ
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 1:5515 LITTLE NECK PARKWAY SUITE L10
Mailing Address - Street 2:GARY F SPITZ MD
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362
Mailing Address - Country:US
Mailing Address - Phone:718-352-6700
Mailing Address - Fax:718-352-6777
Practice Address - Street 1:5515 LITTLE NECK PARKWAY SUITE L10
Practice Address - Street 2:GARY F SPITZ MD
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362
Practice Address - Country:US
Practice Address - Phone:718-352-6700
Practice Address - Fax:718-352-6777
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1467542207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61508Medicare ID - Type Unspecified
B11983Medicare UPIN