1699033308 NPI number — LAWRENCE SPIEGEL DPT

Table of content: LAWRENCE SPIEGEL DPT (NPI 1699033308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699033308 NPI number — LAWRENCE SPIEGEL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPIEGEL
Provider First Name:
LAWRENCE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699033308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 AURORA AVE N
Provider Second Line Business Mailing Address:
APT S402
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98103-7379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-376-6677
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1580 SAWGRASS CORPORATE PKWY
Provider Second Line Business Practice Location Address:
MEDPRO HEALTHCARE STAFFING SUITE 100
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-739-4247
Provider Business Practice Location Address Fax Number:
800-370-0755
Provider Enumeration Date:
05/01/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  32022 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT60265996 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)