Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | MD 01408 | NJ |
Y | 222Z00000X | Podiatrist | MD 01408 | NJ |
N | 213E00000X | Podiatrist | N003026 | NY |
N | 222Z00000X | Podiatrist | N003026 | NY |
NPI | 1023011954 |
---|---|
Provider Name | Dr. Terry Lee Spilken |
First Address | Edison, NJ 08837-3224 |
Second Address | Edison, NJ 08837-3224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T45023 | (02) | NJ |