Healthcare Provider Details

I. General information

NPI: 1285807800
Provider Name (Legal Business Name): THEODORE ERICH SPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BENJAMIN TRL
PENNINGTON NJ
08534-9747
US

IV. Provider business mailing address

11 BENJAMIN TRL
PENNINGTON NJ
08534-9747
US

V. Phone/Fax

Practice location:
  • Phone: 609-737-5118
  • Fax: 609-737-8503
Mailing address:
  • Phone: 609-737-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA05383600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA053883600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: