Provider Demographics
NPI:1326132499
Name:STEPHANIE E SIEGRIST MD LLC
Entity Type:Organization
Organization Name:STEPHANIE E SIEGRIST MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SENATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-271-4272
Mailing Address - Street 1:980 WESTFALL RD
Mailing Address - Street 2:BLDG. 100, SUITE 105
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2605
Mailing Address - Country:US
Mailing Address - Phone:585-271-4272
Mailing Address - Fax:585-730-6936
Practice Address - Street 1:980 WESTFALL RD
Practice Address - Street 2:BLDG. 100, SUITE 105
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2605
Practice Address - Country:US
Practice Address - Phone:585-271-4272
Practice Address - Fax:585-730-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199450207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01685432Medicaid
NYG12364Medicare UPIN
NY01685432Medicaid