Provider Demographics
NPI:1770699472
Name:SPEVETZ, ANTOINETTE (MD)
Entity type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:
Last Name:SPEVETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-342-2921
Mailing Address - Fax:856-968-8499
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:CRITICAL CARE UNIT
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2657
Practice Address - Fax:856-968-8306
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04916400207RC0200X
MDD0047631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1804768OtherPA BLUE SHIELD
42467OtherUNIVERSITY HEALTHPLAN
P3667772OtherOXFORD
001007847OtherAMERICHOICE
2640936000OtherAMERIHEALTH, KEYSTONE, IBC
3K6059OtherHEALTHNET
1160341OtherAETNA
1270717OtherCIGNA
2621896OtherUNITED HEALTHCARE
P00307378OtherRR MEDICARE
NJ0093131Medicaid
60021643OtherHORIZON NJ HEALTH
2640936000OtherAMERIHEALTH, KEYSTONE, IBC
P00307378OtherRR MEDICARE