Provider Demographics
NPI:1659434520
Name:SIEGAL, MICHAEL SELIG (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SELIG
Last Name:SIEGAL
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 1:115 E 57TH ST
Mailing Address - Street 2:SUITE 1540
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2049
Mailing Address - Country:US
Mailing Address - Phone:212-319-1700
Mailing Address - Fax:212-319-3034
Practice Address - Street 1:115 E 57TH ST
Practice Address - Street 2:SUITE 1540
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2049
Practice Address - Country:US
Practice Address - Phone:212-319-1700
Practice Address - Fax:212-319-3034
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08985Medicare UPIN
NY35A431Medicare ID - Type Unspecified