Provider Demographics
NPI:1275527632
Name:SIEGEL, JUDY FRIED
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:FRIED
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 WARBURTON AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-1523
Mailing Address - Country:US
Mailing Address - Phone:914-478-3001
Mailing Address - Fax:914-478-3001
Practice Address - Street 1:623 WARBURTON AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-1523
Practice Address - Country:US
Practice Address - Phone:914-478-3001
Practice Address - Fax:914-478-3001
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1830621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53T331OtherEMPIRE #
NYP466087OtherOXFORD #
NY01679556Medicaid
NY2565890OtherAETNA HMO #
NY1000593OtherGHI PPO #
NY134181009OtherTAX IDENTIFICATION #
NY5411447OtherAETNA PPO #
NY2565890OtherAETNA HMO #
NY01679556Medicaid