Healthcare Provider Details

I. General information

NPI: 1720400906
Provider Name (Legal Business Name): KRISTEN RENEE SPENCER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PL MEB 486
NEW BRUNSWICK NJ
08901-1928
US

IV. Provider business mailing address

1 ROBERT WOOD JOHNSON PL MEB 484A
NEW BRUNSWICK NJ
08901-1928
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-8377
  • Fax:
Mailing address:
  • Phone: 732-235-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number25MB09524300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number316527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: