Healthcare Provider Details

I. General information

NPI: 1922332261
Provider Name (Legal Business Name): ERIC R.B. SPRONZ RN CASAC NPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 MIDDLE COUNTRY RD SUITE 4
CENTEREACH NY
11720-3551
US

IV. Provider business mailing address

2539 MIDDLE COUNTRY RD SUITE 4
CENTEREACH NY
11720-3551
US

V. Phone/Fax

Practice location:
  • Phone: 631-737-6434
  • Fax:
Mailing address:
  • Phone: 631-737-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402014
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17808
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number664292
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number298173
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: