MEDICARE: DR. JACLYN B SPITZER PH.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	237600000X	Audiologist-Hearing Aid Fitter	14000009245	NY
2	231H00000X	Audiologist	001550	NY

General Provider Information

NPI Number	:	1265435317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYN B SPITZER PH.D.

Provider Business Mailing Address
First Line	:	180 FORT WASHINGTON AVE
Second Line	:	7TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10032-3722
Country	:	US
Telephone Number	:	212-305-8555
Fax Number	:	212-305-3975

Provider Business Practice Location Address
First Line	:	180 FORT WASHINGTON AVE
Second Line	:	7TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10032-3722
Country	:	US
Telephone Number	:	212-305-8555
Fax Number	:	212-305-3975

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/11/2014

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