Individual
DR. JACQUELINE M SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1452 DEER PARK AVE, NORTH BABYLON, NY 11703
(631) 254-8500
(631) 254-8503
Mailing address
4567 CROSSROADS PARK DR., LIVERPOOL, NY 13088
(315) 295-2100
(315) 295-2125
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
214310
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02109855
—
NY
Enumeration date
08/22/2005
Last updated
03/09/2009
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