Provider Demographics
NPI:1639154610
Name:SIEGELSON, DORE (PT)
Entity Type:Individual
Prefix:
First Name:DORE
Middle Name:
Last Name:SIEGELSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DORE
Other - Middle Name:
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:70 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4225
Mailing Address - Country:US
Mailing Address - Phone:516-536-7388
Mailing Address - Fax:
Practice Address - Street 1:70 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4225
Practice Address - Country:US
Practice Address - Phone:516-536-7388
Practice Address - Fax:516-608-6717
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016540-1225100000X
NY016540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ07U91OtherPHYSICAL THERAPY
NYQ29052OtherPHYSICAL THERAPY
NY07556OtherPHYSICAL THERAPY
NY07556OtherPHYSICAL THERAPY