Provider Demographics
NPI:1326043142
Name:SPECTOR, BORIS (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:BORIS
Middle Name:
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NOTRE DAME AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2237
Mailing Address - Country:US
Mailing Address - Phone:917-734-4533
Mailing Address - Fax:718-627-8737
Practice Address - Street 1:1833 E 13TH ST STE CA
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2885
Practice Address - Country:US
Practice Address - Phone:718-627-3939
Practice Address - Fax:718-627-8737
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2019-02-25
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
NY017736208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation