Provider Demographics
NPI:1881863801
Name:SPIRATOS, PETER ALEX
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ALEX
Last Name:SPIRATOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 HIGBIE LN
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1610
Mailing Address - Country:US
Mailing Address - Phone:631-587-3530
Mailing Address - Fax:
Practice Address - Street 1:2060 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6018
Practice Address - Country:US
Practice Address - Phone:631-666-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00513084Medicaid