1912986746 NPI number — DR. JESSICA E SIGEL MD

Table of content: DR. JESSICA E SIGEL MD (NPI 1912986746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912986746 NPI number — DR. JESSICA E SIGEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIGEL
Provider First Name:
JESSICA
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1912986746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7111 FAIRWAY DR
Provider Second Line Business Mailing Address:
#400
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33418-4204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-330-6565
Provider Business Mailing Address Fax Number:
800-330-6565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7730 FIRST PL
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
OAKWOOD VILLAGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44146-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-703-2100
Provider Business Practice Location Address Fax Number:
440-703-2100
Provider Enumeration Date:
01/11/2006

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: 207ZP0102X , with the licence number:  35.074471 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZD0900X , with the licence number: 35.074471 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2305508 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 58005978100 . This is a "BUREAU OF WORKERS COMPENSATION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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