Provider Demographics
NPI:1043565294
Name:SIEGEL, DORA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15044 73RD AVE
Mailing Address - Street 2:APT 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15044 73RD AVE
Practice Address - Street 2:APT 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2640
Practice Address - Country:US
Practice Address - Phone:646-884-2804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator