Provider Demographics
NPI:1588937742
Name:STEPHEN D. SIEGEL, MD, PC
Entity type:Organization
Organization Name:STEPHEN D. SIEGEL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-879-8000
Mailing Address - Street 1:3 E 71ST ST
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4154
Mailing Address - Country:US
Mailing Address - Phone:212-879-8000
Mailing Address - Fax:212-288-5961
Practice Address - Street 1:3 E 71ST ST
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4154
Practice Address - Country:US
Practice Address - Phone:212-879-8000
Practice Address - Fax:212-288-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161427261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22E801Medicare PIN
NYA61353Medicare UPIN