Basic Information
| Provider Information | |||||||||
| NPI: | 1003011891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPIRA | ||||||||
| FirstName: | ETAN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 FRANKLIN AVE | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071093532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737597240 | ||||||||
| FaxNumber: | 9737597243 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 FRANKLIN AVE | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071093532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737597240 | ||||||||
| FaxNumber: | 9737597243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 02/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 25MA09471300 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0415588 | 05 | NJ | MEDICAID |