Provider Demographics
NPI:1013900935
Name:SFERRAZZA, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SFERRAZZA
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 1:235 POND VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050
Mailing Address - Country:US
Mailing Address - Phone:516-944-5105
Mailing Address - Fax:516-944-5105
Practice Address - Street 1:25910 HILLSIDE AVE
Practice Address - Street 2:SUITE L3
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1649
Practice Address - Country:US
Practice Address - Phone:718-343-8396
Practice Address - Fax:718-343-6746
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0822301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B03063Medicare UPIN
136682JSMedicare ID - Type Unspecified