Provider Demographics
NPI:1487611711
Name:SASPORTAS, CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:SASPORTAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:70 CHARLES LINDBERGH BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11553-3634
Practice Address - Country:US
Practice Address - Phone:516-483-2020
Practice Address - Fax:516-560-1855
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02573462Medicaid
NY02573462Medicaid
NY001SF1Medicare ID - Type Unspecified