Provider Demographics
NPI:1306064753
Name:ELEANOR A SIEGEL
Entity type:Organization
Organization Name:ELEANOR A SIEGEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-294-9694
Mailing Address - Street 1:495 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3069
Mailing Address - Country:US
Mailing Address - Phone:732-294-9694
Mailing Address - Fax:732-294-7470
Practice Address - Street 1:495 IRON BRIDGE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3069
Practice Address - Country:US
Practice Address - Phone:732-294-9694
Practice Address - Fax:732-294-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00107300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00314000OtherNEW JERSEY PLUS
NJ105113OtherMANAGED HEALTH NETWORK
NJ00314000OtherMAGELLAN
NJ4220195OtherAETNA
NJ00314000OtherMAGELLAN