Provider Demographics
NPI:1972549988
Name:SPODAK, JEFFREY (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:SPODAK
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 5TH AVE RM 1606
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6649
Mailing Address - Country:US
Mailing Address - Phone:646-662-1938
Mailing Address - Fax:888-498-0866
Practice Address - Street 1:303 5TH AVE RM 1707
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6641
Practice Address - Country:US
Practice Address - Phone:646-662-1938
Practice Address - Fax:888-498-0866
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical