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General NPI Number Information
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NPI Number | 1639573769
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Entity Type | Organization
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Legal Business Name | VINCENT SPERANDEO NP IN FAMILY HEALTH PLLC
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 1174 ROUTE 112 SUITE C
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-8033
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Country | US
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Telephone | 631-320-7503
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Fax |
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Provider Business Mailing Address
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Address Line | 1174 ROUTE 112 SUITE C
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-8033
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Country | US
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Telephone | 631-320-7503
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. VINCENT SPERANDEO
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Credential | DNP
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Telephone | 631-312-2838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 333169
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License Number State | NY
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