Provider Demographics
NPI:1225150808
Name:SIEGEL, JULIE ELLEN
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ELLEN
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ELLEN
Other - Last Name:SYAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:21418 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2103
Mailing Address - Country:US
Mailing Address - Phone:718-352-0223
Mailing Address - Fax:718-352-6287
Practice Address - Street 1:21418 41ST AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2103
Practice Address - Country:US
Practice Address - Phone:718-352-0223
Practice Address - Fax:718-352-6287
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008295-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02379GMedicare ID - Type Unspecified
NYU65061Medicare UPIN