Provider Demographics
NPI:1861450264
Name:SIEGEL, MARTIN J (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2811
Mailing Address - Country:US
Mailing Address - Phone:201-333-2768
Mailing Address - Fax:201-333-3145
Practice Address - Street 1:127 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-333-2768
Practice Address - Fax:201-333-3145
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA003827152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4704100Medicaid
NJ4704100Medicaid
NJ714837BETMedicare PIN