MEDICARE: DR. RUTH SPECTOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	171197	NY
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	C1-0025467	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104815497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUTH SPECTOR M.D.

Provider Business Mailing Address
First Line	:	21 FOX HUNT LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11020-1229
Country	:	US
Telephone Number	:	516-829-4020
Fax Number	:	516-829-4020

Provider Business Practice Location Address
First Line	:	21 FOX HUNT LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11020-1229
Country	:	US
Telephone Number	:	516-829-4020
Fax Number	:	516-829-4020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	10/26/2022

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