Provider Demographics
NPI:1205998937
Name:SPECTOR, JENNIFER JOYCE (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOYCE
Last Name:SPECTOR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:JOYCE
Other - Last Name:STOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:127 CHURCH RD
Mailing Address - Street 2:STE 700
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9425
Mailing Address - Country:US
Mailing Address - Phone:484-521-0233
Mailing Address - Fax:
Practice Address - Street 1:648 CHILDS AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3805
Practice Address - Country:US
Practice Address - Phone:484-521-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005777213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4299830001Medicare NSC
PA109528QDOMedicare PIN
PAV11983Medicare UPIN