MEDICARE: AVIGAIL SPETNER NP

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	163W00000X	Registered Nurse	702131	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	402931	NY

General Provider Information

NPI Number	:	1992173959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVIGAIL SPETNER NP

Provider Business Mailing Address
First Line	:	1484 E 18TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6706
Country	:	US
Telephone Number	:	513-824-1428
Fax Number	:

Provider Business Practice Location Address
First Line	:	1484 E 18TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6706
Country	:	US
Telephone Number	:	513-824-1428
Fax Number	:

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

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	03/18/2020

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