Spectrum Healthcare Derby, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2236 Issued in CT

Legal business name

SPECTRUM HEALTHCARE DERBY, LLC

Practice address

210 Chatfield St
Derby, CT 06418-1150

Phone

(860) 871-5454

Fax

(860) 871-5757

NPI assigned

Nov 7, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Howard William Dickstein, PHD

Title

Chief Executive Officer

Phone

(860) 871-5454

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Birmingham Health Center Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1144201344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 CHATFIELD ST",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181150",
            "telephone_number": "860-871-5454",
            "fax_number": "860-871-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 CHATFIELD ST",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181150",
            "telephone_number": "860-871-5454",
            "fax_number": "860-871-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTHCARE DERBY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "DICKSTEIN",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "860-871-5454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2236",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010587",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Birmingham Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Leland J Soto III, MD
• Raina Sotsky, M.D.
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• David Spadaro, D.C
• Kenneth S Spector, MD PHD
• Biannca Squires, LPC
• Elizabeth Anne Starnes, APRN
• Peter J Stein, O.D.
• Celeste Stewart
• Storm Engine Co Ambulance Corps

• Skilled Nursing Facility in Derby, CT
• Providers in Derby, CT by specialty
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.