Provider Demographics
NPI:1821099904
Name:SIEGEL, DANA B (DPM)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:B
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 STACEY LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2354
Mailing Address - Country:US
Mailing Address - Phone:631-206-3106
Mailing Address - Fax:631-206-3108
Practice Address - Street 1:2111 UNION BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8017
Practice Address - Country:US
Practice Address - Phone:631-206-3106
Practice Address - Fax:631-206-3108
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005107213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01688884Medicaid
NY01688884Medicaid
U59414Medicare UPIN