Provider Demographics
NPI:1194822569
Name:SIEGELMAN, LOUIS IRA (DDS)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:IRA
Last Name:SIEGELMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WEST 57TH STREET
Mailing Address - Street 2:SUITE 815
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2401
Mailing Address - Country:US
Mailing Address - Phone:212-974-8737
Mailing Address - Fax:212-247-5350
Practice Address - Street 1:119 WEST 57TH STREET
Practice Address - Street 2:SUITE 815
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2401
Practice Address - Country:US
Practice Address - Phone:212-974-8737
Practice Address - Fax:212-247-5350
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0359401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice