Basic Information
Provider Information
NPI: 1578004271
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPECHT
FirstName: ISRAEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7401 W WASHINGTON AVE APT 1050
Address2: #1050
City: LAS VEGAS
State: NV
PostalCode: 891284308
CountryCode: US
TelephoneNumber: 5209777746
FaxNumber:  
Practice Location
Address1: 2126 ROCKROSE CIR
Address2:  
City: HENDERSON
State: NV
PostalCode: 890741525
CountryCode: US
TelephoneNumber: 6025920503
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/14/2017
LastUpdateDate: 03/15/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  Y    

No ID Information.


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