Provider Demographics
NPI:1366450553
Name:JEFFREY S. SPECTOR, M.D., S.C.
Entity Type:Organization
Organization Name:JEFFREY S. SPECTOR, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-433-8884
Mailing Address - Street 1:450 CENTRAL AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2684
Mailing Address - Country:US
Mailing Address - Phone:847-433-8884
Mailing Address - Fax:847-433-5345
Practice Address - Street 1:450 CENTRAL AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2684
Practice Address - Country:US
Practice Address - Phone:847-433-8884
Practice Address - Fax:847-433-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C43966Medicare UPIN