Provider Demographics
NPI:1215049341
Name:SPERBER, KIRK (MD)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
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 1:325 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2779
Mailing Address - Country:US
Mailing Address - Phone:631-659-4491
Mailing Address - Fax:631-659-4580
Practice Address - Street 1:325 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2779
Practice Address - Country:US
Practice Address - Phone:631-659-4491
Practice Address - Fax:631-659-4580
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162109207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01789344Medicaid
NY412221OtherMVP
NY6N0641OtherBCBS OF NY
NY0132293OtherGHI PPO
NY4237155OtherAETNA PPO
4C2180OtherHEALTHNET
NY000000114235OtherGHI HMO
NY1467779OtherAETNA HMO
NS4191OtherOXFORD
4C2180OtherHEALTHNET