Provider Demographics
NPI:1508833815
Name:SIEGEL, ROBERT ERROL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ERROL
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-1932
Mailing Address - Country:US
Mailing Address - Phone:914-747-2507
Mailing Address - Fax:
Practice Address - Street 1:130 W. KINGSBRIDGE ROAD
Practice Address - Street 2:JAMES J. PETERS VA MEDICAL CENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3904
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:718-741-4623
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149778207RC0200X
SC32556207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4306OtherMEDICAID GROUP
SCGP3912OtherMEDICAID GROUP
SC325561Medicaid
NY01N81Medicare UPIN
SC325561Medicaid
SCAA57227153Medicare PIN
SCGP3912OtherMEDICAID GROUP