Provider Demographics
NPI:1114990546
Name:SPECTOR, DONALD (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:SPECTOR
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 1:259 W 231ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3903
Mailing Address - Country:US
Mailing Address - Phone:718-548-3080
Mailing Address - Fax:718-548-3157
Practice Address - Street 1:259 W 231ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3903
Practice Address - Country:US
Practice Address - Phone:718-548-3080
Practice Address - Fax:718-548-3157
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3990213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY36812POtherHIP PROVIDER NUMBER
NY00908787Medicaid
NY00908787Medicaid
NYP41232Medicare PIN