Provider Demographics
NPI:1063596302
Name:SPIEGEL, MARK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:SPIEGEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7711 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4659
Mailing Address - Country:US
Mailing Address - Phone:718-424-5294
Mailing Address - Fax:
Practice Address - Street 1:257 PARK AVE S
Practice Address - Street 2:EPILEPSY FOUNDATION OF METROPOLITAN NEW YORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7304
Practice Address - Country:US
Practice Address - Phone:212-677-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1277822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO5514Medicare UPIN