Basic Information
| Provider Information | |||||||||
| NPI: | 1861473498 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SPECHT | ||||||||
| FirstName: | NEIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9135 | ||||||||
| Address2: | ATT:SHARON SILVA | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024469135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009270002 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066064201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035765067 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 03/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 027045 | CT | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207R00000X | 027045 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001270454 | 05 | CT | MEDICAID |