Provider Demographics
NPI:1891972808
Name:SPERO E DEMOLEAS
Entity type:Organization
Organization Name:SPERO E DEMOLEAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPERO
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEMOLEAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-693-8479
Mailing Address - Street 1:631 SAW MILL RIVER RD
Mailing Address - Street 2:STE 1S
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2146
Mailing Address - Country:US
Mailing Address - Phone:914-693-8479
Mailing Address - Fax:914-693-8678
Practice Address - Street 1:631 SAW MILL RIVER RD
Practice Address - Street 2:STE 1S
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2146
Practice Address - Country:US
Practice Address - Phone:914-693-8479
Practice Address - Fax:914-693-8678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0043801213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5736980001Medicare NSC