Provider Demographics
NPI:1154450518
Name:SIEGEL, GERALD G (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:G
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 COLUMBIA TPKE STE 102
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1231
Mailing Address - Country:US
Mailing Address - Phone:973-660-0100
Mailing Address - Fax:973-660-0117
Practice Address - Street 1:256 COLUMBIA TPKE STE 102
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1231
Practice Address - Country:US
Practice Address - Phone:973-660-0100
Practice Address - Fax:973-660-0117
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ1155103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ019522Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER