Healthcare Provider Details

I. General information

NPI: 1518961986
Provider Name (Legal Business Name): ANGELO SPARAGNA III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BETHEL RD
SOMERS POINT NJ
08244-2060
US

IV. Provider business mailing address

425 BETHEL RD
SOMERS POINT NJ
08244-2060
US

V. Phone/Fax

Practice location:
  • Phone: 609-927-1163
  • Fax: 609-927-3909
Mailing address:
  • Phone: 609-927-1163
  • Fax: 609-927-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA32948
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: