Provider Demographics
NPI:1063561744
Name:SPERBER, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:SPERBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 S JENSEN RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2821
Mailing Address - Country:US
Mailing Address - Phone:607-770-9000
Mailing Address - Fax:607-770-1637
Practice Address - Street 1:113 S JENSEN RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2821
Practice Address - Country:US
Practice Address - Phone:607-770-9000
Practice Address - Fax:607-770-1637
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177414-1207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01665392Medicaid
NY1539123OtherUNITED HEALTH CARE
NY180029198OtherUHC RAILROAD MEDICARE
NY989809OtherMVP
NY4498545OtherAETNA
NY10032773OtherCDPHP
NY1539123OtherUNITED HEALTH CARE
NY01665392Medicaid