Provider Demographics
NPI:1962493130
Name:SPRONG, JAY W (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:W
Last Name:SPRONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2018
Mailing Address - Country:US
Mailing Address - Phone:413-584-2303
Mailing Address - Fax:413-586-3212
Practice Address - Street 1:61 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2018
Practice Address - Country:US
Practice Address - Phone:413-584-2303
Practice Address - Fax:413-586-3212
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40658207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG14106OtherBCBS MA
MA130758OtherHARVARD PILGRIM
MA406581OtherCONNECTICARE
MA040658OtherTUFTS
MA16668OtherHEALTH NEW ENGLAND
MA2359285OtherAETNA
MA524271OtherCIGNA
MA000000006741OtherBMC HEALTHNET
MA2055899Medicaid
MA130758OtherHARVARD PILGRIM
MA2359285OtherAETNA