1538163290 NPI number — DR. AUDRA ROCHELLE SIEGEL DPM

Table of content: DR. AUDRA ROCHELLE SIEGEL DPM (NPI 1538163290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538163290 NPI number — DR. AUDRA ROCHELLE SIEGEL DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEGEL
Provider First Name:
AUDRA
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1538163290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 NORTH RD STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-1173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-451-7251
Provider Business Mailing Address Fax Number:
845-471-7372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
696 DUTCHESS TPKE STE M
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12603-6429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-464-0630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2005

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: 213E00000X , with the licence number:  65 006034 , 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: 1235164997 . This is a "NPI GROUP ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: AS00573K10 . This is a "BLUE CROSS BLUE SHIELD PIN/IDENTIFIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10111279 . This is a "CDPHP PIN/IDENTIFIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200053170 . This is a "MVP HEALTHCARE GROUP ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65 006034 . This is a "NYS PROFESSIONAL LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02754227 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4148374 . This is a "MVP HEALTHCARE PIN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com