Provider Demographics
NPI:1861781619
Name:PETER SPERICO NURSE PRACTITIONER IN F
Entity type:Organization
Organization Name:PETER SPERICO NURSE PRACTITIONER IN F
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SPERICO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:516-455-3413
Mailing Address - Street 1:1056 GARDINER DRIVE
Mailing Address - Street 2:PETER SPERICO NURSE PRACTITIONER IN FAMILY HEALTH PC
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6314
Mailing Address - Country:US
Mailing Address - Phone:516-455-3413
Mailing Address - Fax:631-969-0093
Practice Address - Street 1:1056 GARDINER DRIVE
Practice Address - Street 2:PETER SPERICO NURSE PRACTITIONER IN FAMILY HEALTH PC
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6314
Practice Address - Country:US
Practice Address - Phone:516-455-3413
Practice Address - Fax:631-969-0093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER SPERICO NURSE PRACTITIONER IN FAMILY HEALT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-01
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY409409163W00000X
NY336101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty