1275527632 NPI number — JUDY FRIED SIEGEL

Table of content: JUDY FRIED SIEGEL (NPI 1275527632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275527632 NPI number — JUDY FRIED SIEGEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEGEL
Provider First Name:
JUDY
Provider Middle Name:
FRIED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275527632
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
623 WARBURTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASTINGS ON HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10706-1523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-478-3001
Provider Business Mailing Address Fax Number:
914-478-3001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
623 WARBURTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS ON HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10706-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-478-3001
Provider Business Practice Location Address Fax Number:
914-478-3001
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  1830621 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 53T331 . This is a "EMPIRE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P466087 . This is a "OXFORD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01679556 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2565890 . This is a "AETNA HMO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000593 . This is a "GHI PPO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 134181009 . This is a "TAX IDENTIFICATION #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5411447 . This is a "AETNA PPO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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