Provider Demographics
NPI:1295277515
Name:SPRARAGEN, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SPRARAGEN
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 1:422 NOCELLA CT
Mailing Address - Street 2:
Mailing Address - City:W HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3022
Mailing Address - Country:US
Mailing Address - Phone:516-581-8097
Mailing Address - Fax:
Practice Address - Street 1:422 NOCELLA CT
Practice Address - Street 2:
Practice Address - City:W HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3022
Practice Address - Country:US
Practice Address - Phone:516-581-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268084031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist