Healthcare Provider Details

I. General information

NPI: 1962578757
Provider Name (Legal Business Name): GARY SPIERER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2006
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 CROMWELL AVE
STATEN ISLAND NY
10304-3933
US

IV. Provider business mailing address

78 CROMWELL AVE
STATEN ISLAND NY
10304-3933
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-9175
  • Fax: 718-987-1678
Mailing address:
  • Phone: 718-987-9175
  • Fax: 718-987-1678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number128777
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: