MEDICARE: MR. ERIC R.B. SPRONZ RN CASAC NPP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	402014	NY
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	17808	NY
3	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	664292	NY
4	164W00000X	Licensed Practical Nurse	298173	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	:	1922332261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC R.B. SPRONZ RN CASAC NPP

Provider Business Mailing Address
First Line	:	2539 MIDDLE COUNTRY RD
Second Line	:	SUITE 4
City	:	CENTEREACH
State	:	NY
Zip	:	11720-3551
Country	:	US
Telephone Number	:	631-737-6434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 MIDDLE COUNTRY RD
Second Line	:	SUITE 4
City	:	CENTEREACH
State	:	NY
Zip	:	11720-3551
Country	:	US
Telephone Number	:	631-737-6434
Fax Number	:

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

Provider Enumeration Date	:	09/18/2009
Last Update Date	:	10/19/2020

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