Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 308893 | NY |
N | 207Q00000X | Family Doctor | OS019665 | PA |
NPI | 1003201872 |
---|---|
Provider Name | Andrea Elizabeth Spiekhout |
First Address | Bronx, NY 10461-2507 |
Second Address | Bronx, NY 10453-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 27/05/2021 |