Provider Demographics
NPI:1053078816
Name:SPYDELL, JOHN DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:SPYDELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 US HIGHWAY 46 STE 420
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1532
Mailing Address - Country:US
Mailing Address - Phone:973-882-3456
Mailing Address - Fax:
Practice Address - Street 1:700 US HIGHWAY 46 STE 420
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1532
Practice Address - Country:US
Practice Address - Phone:973-882-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic