MEDICARE: MR. SPENCER B. HAMILTON CIEC #23060

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	171WH0202X	Home Modifications Contractor	13VH04976900	NJ

General Provider Information

NPI Number	:	1174312078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SPENCER B. HAMILTON CIEC #23060

Provider Business Mailing Address
First Line	:	104 SHORE RD
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-2507
Country	:	US
Telephone Number	:	609-703-1311
Fax Number	:	609-703-1311

Provider Business Practice Location Address
First Line	:	104 SHORE RD
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-2507
Country	:	US
Telephone Number	:	609-703-1311
Fax Number	:	609-703-1311

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

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/06/2025

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