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NPI Code Detail

MEDICARE: ETHEL SPEYERER RN

MEDICARE: ETHEL SPEYERER RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor233782NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093168684
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHEL SPEYERER RN
Provider Business Mailing Address
First Line : PO BOX 1188
Second Line :
City : ALBANY
State : NY
Zip : 12201-1188
Country : US
Telephone Number : 518-952-8408
Fax Number : 518-952-8287
Provider Business Practice Location Address
First Line : 8002 KEW GARDENS RD STE 704
Second Line :
City : KEW GARDENS
State : NY
Zip : 11415-3607
Country : US
Telephone Number : 518-952-8408
Fax Number : 518-952-8287
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2016
Last Update Date : 07/19/2016

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