Provider Demographics
NPI:1275529497
Name:SIEGEL, BETH M (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1185
Mailing Address - Fax:718-670-2312
Practice Address - Street 1:56-26 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1185
Practice Address - Fax:718-670-2312
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175945208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01725460Medicaid
NY03487616Medicaid
NY01725460Medicaid