Healthcare Provider Details

I. General information

NPI: 1437086220
Provider Name (Legal Business Name): MAURA ANNE SPAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 E BROADWAY
LONG BEACH NY
11561-4227
US

IV. Provider business mailing address

267 E BROADWAY
LONG BEACH NY
11561-4227
US

V. Phone/Fax

Practice location:
  • Phone: 516-375-2493
  • Fax: 516-375-2493
Mailing address:
  • Phone: 516-375-2493
  • Fax: 516-375-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1796392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: