Provider Demographics
NPI:1023011954
Name:SPILKEN, TERRY LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:SPILKEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 AMBOY AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3224
Mailing Address - Country:US
Mailing Address - Phone:732-738-6100
Mailing Address - Fax:732-536-6477
Practice Address - Street 1:776 AMBOY AVE
Practice Address - Street 2:STE 201
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3224
Practice Address - Country:US
Practice Address - Phone:732-738-6100
Practice Address - Fax:732-536-6477
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD 01408213E00000X
NYN003026213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45023Medicare UPIN
NJ444697Medicare ID - Type Unspecified