Provider Demographics
NPI:1588637391
Name:SIEGEL, STEPHEN A (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-684-1108
Mailing Address - Fax:212-686-5645
Practice Address - Street 1:245 E 35TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-684-1108
Practice Address - Fax:212-686-5645
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143094207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00824891Medicaid
90A641Medicare ID - Type Unspecified
B87401Medicare UPIN