Provider Demographics
NPI:1962581009
Name:SPEEZ, NANCY SPRAGUE (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SPRAGUE
Last Name:SPEEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:SPEEZ
Other - Last Name:LIEBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:520 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5402
Mailing Address - Country:US
Mailing Address - Phone:201-670-8608
Mailing Address - Fax:
Practice Address - Street 1:765 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4248
Practice Address - Country:US
Practice Address - Phone:201-833-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07162700208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0095338Medicaid
NJF39598Medicare UPIN
NJ064396Medicare ID - Type Unspecified