Provider Demographics
NPI:1194903385
Name:SIEGEL, ERICA LYNN (LAC)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LYNN
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BROADWAY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1210
Mailing Address - Country:US
Mailing Address - Phone:718-541-4931
Mailing Address - Fax:
Practice Address - Street 1:900 BROADWAY
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1210
Practice Address - Country:US
Practice Address - Phone:718-541-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003259-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist