Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 545136 | NY |
NPI | 1013164110 |
---|---|
Provider Name | Mr. Patrick Spencer |
First Address | Astoria, NY 11102-3479 |
Second Address | New York, NY 10029-6542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 11/10/2021 |