Provider Demographics
NPI:1053079418
Name:SIEGEL, GREGORY VETRANO (PMHNP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:VETRANO
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3943
Mailing Address - Country:US
Mailing Address - Phone:914-319-8169
Mailing Address - Fax:
Practice Address - Street 1:6043 MADISON ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11385-3943
Practice Address - Country:US
Practice Address - Phone:914-319-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405005363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health