Active NPI
Michael Spivak, D.O.
- Diagnostic Radiology Physician
- Vineland, NJ
National Provider Identifier
1063484970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 25MB0218077
- Practice address
- 1505 W Sherman Ave
Vineland, NJ 08360-6912 - Phone
- (610) 459-3113
- NPI assigned
- Feb 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 25MB0218077 | NJ | Primary |
Addresses
Primary practice location
1505 W Sherman Ave
Vineland, NJ 08360-6912
Mailing address
1505 W Sherman Ave
Vineland, NJ 08360-6912
Phone (610) 459-3113
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MB0218077 | NJ | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221696000000",
"number": "1063484970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1505 W SHERMAN AVE",
"city": "VINELAND",
"state": "NJ",
"postal_code": "083606912",
"telephone_number": "610-459-3113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 W SHERMAN AVE",
"city": "VINELAND",
"state": "NJ",
"postal_code": "083606912",
"telephone_number": "610-459-3113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPIVAK",
"first_name": "MICHAEL",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-03",
"last_updated": "2008-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NJ",
"license": "25MB0218077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vineland, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.