Provider Demographics
NPI:1720236516
Name:CAROL SASPORTAS MD LLC
Entity Type:Organization
Organization Name:CAROL SASPORTAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SASPORTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-454-2500
Mailing Address - Street 1:7568 187TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1726
Mailing Address - Country:US
Mailing Address - Phone:718-454-2500
Mailing Address - Fax:718-454-8500
Practice Address - Street 1:7568 187TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1726
Practice Address - Country:US
Practice Address - Phone:718-454-2500
Practice Address - Fax:718-454-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001SF1OtherMEDICARE ID TYPE UNSPECIFIED
NY02573462Medicaid
NY001SF1OtherMEDICARE ID TYPE UNSPECIFIED