1770699472 NPI number — DR. ANTOINETTE SPEVETZ M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770699472 NPI number — DR. ANTOINETTE SPEVETZ M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SPEVETZ

Provider First Name:

ANTOINETTE

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1770699472

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/25/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3 COOPER PLZ

Provider Second Line Business Mailing Address:

SUITE 502

Provider Business Mailing Address City Name:

CAMDEN

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08103-1438

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

856-342-2921

Provider Business Mailing Address Fax Number:

856-968-8499

Provider First Line Business Practice Location Address:

1 COOPER PLZ

Provider Second Line Business Practice Location Address:

CRITICAL CARE UNIT

Provider Business Practice Location Address City Name:

CAMDEN

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08103-1461

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-342-2657

Provider Business Practice Location Address Fax Number:

856-968-8306

Provider Enumeration Date:

08/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0200X , with the licence number:  MA04916400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207R00000X , with the licence number: D0047631 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 1804768 . This is a "PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 42467 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: P3667772 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 001007847 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2640936000 . This is a "AMERIHEALTH, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
• Identifier: 3K6059 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: 1160341 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 1270717 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2621896 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: P00307378 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0093131 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 60021643 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".