Provider Demographics
NPI:1699063511
Name:SEIDEL, JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:SEIDEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2231
Mailing Address - Country:US
Mailing Address - Phone:410-426-5508
Mailing Address - Fax:
Practice Address - Street 1:1874 W HILLSBORO BLVD STE F
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1420
Practice Address - Country:US
Practice Address - Phone:954-426-4544
Practice Address - Fax:954-426-4533
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01551213ES0103X
FLPO3928213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery