Healthcare Provider Details

I. General information

NPI: 1891324323
Provider Name (Legal Business Name): COREY SPECTOR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

211 THOMPSON ST APT 6J
NEW YORK NY
10012-1368
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2751
  • Fax:
Mailing address:
  • Phone: 330-607-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO210012370
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number336566
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: