Healthcare Provider Details

I. General information

NPI: 1265435317
Provider Name (Legal Business Name): JACLYN B SPITZER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT WASHINGTON AVE 7TH FLOOR
NEW YORK NY
10032-3722
US

IV. Provider business mailing address

180 FORT WASHINGTON AVE 7TH FLOOR
NEW YORK NY
10032-3722
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-8555
  • Fax: 212-305-3975
Mailing address:
  • Phone: 212-305-8555
  • Fax: 212-305-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number14000009245
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001550
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: