Provider Demographics
NPI:1285780072
Name:ROBERT SPITZ MD, DBA MONTAUK GYN
Entity type:Organization
Organization Name:ROBERT SPITZ MD, DBA MONTAUK GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:MERRILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNATT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-442-9646
Mailing Address - Street 1:342 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4706
Mailing Address - Country:US
Mailing Address - Phone:860-442-9646
Mailing Address - Fax:860-439-0747
Practice Address - Street 1:342 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4706
Practice Address - Country:US
Practice Address - Phone:860-442-9646
Practice Address - Fax:860-439-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001821363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004216356Medicaid
CTP16683Medicare UPIN