Provider Demographics
NPI:1063409191
Name:SIEGEL, WAYNE D (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 ROUTE 3 EAST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094
Mailing Address - Country:US
Mailing Address - Phone:201-866-2400
Mailing Address - Fax:201-866-0444
Practice Address - Street 1:255 ROUTE 3 STE 204
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3857
Practice Address - Country:US
Practice Address - Phone:201-866-2400
Practice Address - Fax:201-866-0444
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50168207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5036801Medicaid
NJE53721Medicare UPIN
NJ5036801Medicaid