Provider Demographics
NPI:1891719555
Name:SPERTUS, SILVANA (DO)
Entity Type:Individual
Prefix:DR
First Name:SILVANA
Middle Name:
Last Name:SPERTUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 ROCKAWAY RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-4408
Mailing Address - Country:US
Mailing Address - Phone:908-832-1347
Mailing Address - Fax:
Practice Address - Street 1:154 ROCKAWAY RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-4408
Practice Address - Country:US
Practice Address - Phone:908-832-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06548900207L00000X
FLOS6533207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7742100Medicaid
NJ7742100Medicaid
NJ023765A01Medicare PIN