Healthcare Provider Details

I. General information

NPI: 1316993595
Provider Name (Legal Business Name): ROBERT SPARTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 LITTLE EAST NECK RD
WEST BABYLON NY
11704-7722
US

IV. Provider business mailing address

170 LITTLE EAST NECK RD
WEST BABYLON NY
11704-7722
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-2345
  • Fax: 631-482-1154
Mailing address:
  • Phone: 631-422-2345
  • Fax: 631-482-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number162586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: