Provider Demographics
NPI:1336127497
Name:COLDEN, SPENCER ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:ADAM
Last Name:COLDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 E 75TH ST
Mailing Address - Street 2:APT 31A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3375
Mailing Address - Country:US
Mailing Address - Phone:917-796-7674
Mailing Address - Fax:646-368-9220
Practice Address - Street 1:1021 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5105
Practice Address - Country:US
Practice Address - Phone:917-796-7674
Practice Address - Fax:646-368-9220
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-08
Last Update Date:2014-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2245292081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH70451Medicare UPIN
NYH70451Medicare UPIN