Healthcare Provider Details

I. General information

NPI: 1639210701
Provider Name (Legal Business Name): LAURA SPERAZZA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W 65TH ST
NEW YORK NY
10023-6601
US

IV. Provider business mailing address

222 EDGEWOOD TER
SOUTH ORANGE NJ
07079-1404
US

V. Phone/Fax

Practice location:
  • Phone: 212-769-6313
  • Fax:
Mailing address:
  • Phone: 973-762-7593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberT005337
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberT005337
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: