Provider Demographics
NPI:1932185972
Name:SEIGEL, ERIC S (PA- C, DFAAPA, PHD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:SEIGEL
Suffix:
Gender:M
Credentials:PA- C, DFAAPA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 COMMACK RD STE 115
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3400
Mailing Address - Country:US
Mailing Address - Phone:631-343-7144
Mailing Address - Fax:631-670-7035
Practice Address - Street 1:283 COMMACK RD STE 115
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3400
Practice Address - Country:US
Practice Address - Phone:631-343-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006809-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
T94016Medicare UPIN
NY571313Medicare ID - Type Unspecified