Provider Demographics
NPI:1447416086
Name:SEIGEL, JAY
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:SEIGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CHANNING ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5735
Mailing Address - Country:US
Mailing Address - Phone:203-303-7387
Mailing Address - Fax:203-303-7387
Practice Address - Street 1:24 CHANNING ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5735
Practice Address - Country:US
Practice Address - Phone:203-303-7387
Practice Address - Fax:203-303-7387
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3815363LP0808X
CT003815363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health