1770584559 NPI number — MICHAEL H SIEGEL MD

Table of content: MICHAEL H SIEGEL MD (NPI 1770584559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770584559 NPI number — MICHAEL H SIEGEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEGEL
Provider First Name:
MICHAEL
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1770584559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 CLARKSON AVE
Provider Second Line Business Mailing Address:
1198
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11203-2056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-270-1603
Provider Business Mailing Address Fax Number:
718-270-2667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 HEMPSTEAD TPKE
Provider Second Line Business Practice Location Address:
500
Provider Business Practice Location Address City Name:
EAST MEADOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11554-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-542-1090
Provider Business Practice Location Address Fax Number:
516-794-8165
Provider Enumeration Date:
08/03/2005

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: 2085R0202X , with the licence number:  132081 , 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: 02256820 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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