Provider Demographics
NPI:1871687384
Name:SPERLING, WALTER LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:LEONARD
Last Name:SPERLING
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 1:60 CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428
Mailing Address - Country:US
Mailing Address - Phone:845-647-5300
Mailing Address - Fax:845-647-7487
Practice Address - Street 1:60 CENTER STREET
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428
Practice Address - Country:US
Practice Address - Phone:845-647-5300
Practice Address - Fax:845-647-7487
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00157002Medicaid
384471Medicare ID - Type Unspecified
NYB14186Medicare UPIN