Provider Demographics
NPI:1083890743
Name:SIEGEL, STEVEN M (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PASSAIC AVE
Mailing Address - Street 2:#15G
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3604
Mailing Address - Country:US
Mailing Address - Phone:973-894-3862
Mailing Address - Fax:
Practice Address - Street 1:215 PASSAIC AVE
Practice Address - Street 2:#15G
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3604
Practice Address - Country:US
Practice Address - Phone:973-894-3862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-12
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01096300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist