1447691845 NPI number — CARMEN M SPECTOR PT

Table of content: CARMEN M SPECTOR PT (NPI 1447691845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447691845 NPI number — CARMEN M SPECTOR PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPECTOR
Provider First Name:
CARMEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALSEIRO
Provider Other First Name:
CARMEN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447691845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8584 EDEN ISLES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRITT ISLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32952-6800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-795-6007
Provider Business Mailing Address Fax Number:
877-787-5595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 WILLARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCOA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32922-7984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-795-6007
Provider Business Practice Location Address Fax Number:
877-787-5595
Provider Enumeration Date:
07/13/2013

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:  PT 2126 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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