Basic Information
| Provider Information | |||||||||
| NPI: | 1164874533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | HAYDEN | ||||||||
| MiddleName: | JARED | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 COMMUNITY DR | ||||||||
| Address2: | |||||||||
| City: | MANHASSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110303876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165620100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 234 EAST 149TH STREET | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795900 | ||||||||
| FaxNumber: | 7185794620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | 309793 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.