Healthcare Provider Details

I. General information

NPI: 1659584332
Provider Name (Legal Business Name): DR. DONALD SPECTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 W 231ST ST
BRONX NY
10463-3903
US

IV. Provider business mailing address

259 W 231ST ST
BRONX NY
10463-3903
US

V. Phone/Fax

Practice location:
  • Phone: 718-548-3080
  • Fax: 718-548-3157
Mailing address:
  • Phone: 718-548-3080
  • Fax: 718-548-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN3990
License Number StateNY

VIII. Authorized Official

Name: DR. DONALD SPECTOR
Title or Position: OWNER
Credential: D.P.M.
Phone: 718-548-3080