Provider Demographics
NPI:1912994286
Name:SPEKTOR, BORIS (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:SPEKTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3700
Practice Address - Street 1:6 WELLNESS WAY STE G12
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2156
Practice Address - Country:US
Practice Address - Phone:518-213-0305
Practice Address - Fax:518-213-0679
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2024-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2186672085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02177659Medicaid
NY02177659Medicaid
NYA400018165Medicare PIN
H41076Medicare UPIN