Healthcare Provider Details

I. General information

NPI: 1831175009
Provider Name (Legal Business Name): MARC SPERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 55TH ST 17TH FL
NEW YORK NY
10022-4540
US

IV. Provider business mailing address

110 E 55TH ST 17TH FL
NEW YORK NY
10022-4540
US

V. Phone/Fax

Practice location:
  • Phone: 212-355-8315
  • Fax: 212-355-9741
Mailing address:
  • Phone: 212-355-8315
  • Fax: 212-355-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number120781
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number120781
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number120781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: