Healthcare Provider Details

I. General information

NPI: 1336127497
Provider Name (Legal Business Name): SPENCER ADAM COLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2006
Last Update Date: 12/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 AVENUE Z
BROOKLYN NY
11235-5105
US

IV. Provider business mailing address

300 E 75TH ST APT 31A
NEW YORK NY
10021-3375
US

V. Phone/Fax

Practice location:
  • Phone: 917-796-7674
  • Fax: 646-368-9220
Mailing address:
  • Phone: 917-796-7674
  • Fax: 646-368-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number224529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: