Provider Demographics
NPI:1306233234
Name:SPENCER, JADE NICOLE (NP)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:NICOLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MADISON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:4215 3RD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4501
Practice Address - Country:US
Practice Address - Phone:718-294-5891
Practice Address - Fax:718-294-2468
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF339320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331952Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331955Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY00695941Medicaid
NY331946Medicare Oscar/Certification
NY331944Medicare Oscar/Certification