MEDICARE: MARK SPITZER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	143098	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306819438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK SPITZER MD

Provider Business Mailing Address
First Line	:	14 MEADOW LN
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1828
Country	:	US
Telephone Number	:	516-355-7802
Fax Number	:	516-467-1387

Provider Business Practice Location Address
First Line	:	1991 MARCUS AVE
Second Line	:	SUITE M215
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-2057
Country	:	US
Telephone Number	:	516-355-7802
Fax Number	:	516-467-1387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	03/24/2017

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