Provider Demographics
NPI:1063453264
Name:ROSE-SIEGALL, DEBORAH (O,D)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:ROSE-SIEGALL
Suffix:
Gender:F
Credentials:O,D
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:20 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4826
Mailing Address - Country:US
Mailing Address - Phone:631-486-3046
Mailing Address - Fax:516-364-7417
Practice Address - Street 1:1850 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1513
Practice Address - Country:US
Practice Address - Phone:631-851-1564
Practice Address - Fax:631-851-1688
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2420859OtherUNITED HEALTHCARE
NY01582705Medicaid
NY7499145OtherAETNA
NYP770635OtherOXFORD
NY2468499OtherAETNA
NY0165096OtherGHI
NY01712087Medicaid
U59683Medicare UPIN
NY2468499OtherAETNA