Provider Demographics
NPI:1770576670
Name:SPECKER, ROBERT W (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:SPECKER
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 1:365 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5803
Mailing Address - Country:US
Mailing Address - Phone:212-929-6155
Mailing Address - Fax:
Practice Address - Street 1:365 W 25TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5803
Practice Address - Country:US
Practice Address - Phone:212-929-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0025161213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P28781Medicare ID - Type Unspecified
T50802Medicare UPIN