Provider Demographics
NPI:1669570719
Name:SPERBER, ALAN BOYO (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BOYO
Last Name:SPERBER
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 1:250 W 94TH ST # 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6954
Mailing Address - Country:US
Mailing Address - Phone:917-859-4784
Mailing Address - Fax:
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:7-SW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:917-859-4784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104169208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00181207Medicaid
NY953961Medicare ID - Type Unspecified
NY00181207Medicaid