MEDICARE: JUSTINE DIANE SPISAK-MOSHER DO

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
1	2084N0400X	Neurology Physician	DO195565	OR
2	2084N0400X	Neurology Physician	DO2230	NV
3	2084N0400X	Neurology Physician	25MB11742000	NJ
4	2084N0400X	Neurology Physician	OS017646	PA

General Provider Information

NPI Number	:	1235421033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE DIANE SPISAK-MOSHER DO

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:	856-988-3444
Fax Number	:	856-988-0553

Provider Business Practice Location Address
First Line	:	1001 ROUTE 73 NORTH MAIN LEVEL
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4524
Country	:	US
Telephone Number	:	856-988-3444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	02/18/2026

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