Provider Demographics
NPI:1831932078
Name:SPEROS, XENOPHON STEPHEN IV (PA-C)
Entity type:Individual
Prefix:MR
First Name:XENOPHON
Middle Name:STEPHEN
Last Name:SPEROS
Suffix:IV
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:45 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1245
Mailing Address - Country:US
Mailing Address - Phone:908-967-4737
Mailing Address - Fax:
Practice Address - Street 1:140 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1049
Practice Address - Country:US
Practice Address - Phone:973-404-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363AS0400X
NJ25MP00859900363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical