Provider Demographics
NPI:1285705954
Name:SPIVAK, STEVEN L (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:SPIVAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 RIVERSIDE DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4176
Mailing Address - Country:US
Mailing Address - Phone:607-798-6700
Mailing Address - Fax:607-798-6745
Practice Address - Street 1:161 RIVERSIDE DR
Practice Address - Street 2:SUITE 306
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4176
Practice Address - Country:US
Practice Address - Phone:607-798-6700
Practice Address - Fax:607-798-6745
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190165207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01376998Medicaid
F42570Medicare UPIN
NY53008FMedicare ID - Type Unspecified