Provider Demographics
NPI:1871658666
Name:SIEGEL, ELLEN (MA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:NADELL-SIEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA-SLP PLLC
Mailing Address - Street 1:16 COLGATE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2222
Mailing Address - Country:US
Mailing Address - Phone:917-868-3737
Mailing Address - Fax:
Practice Address - Street 1:16 COLGATE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2222
Practice Address - Country:US
Practice Address - Phone:917-868-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0041441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0041441OtherSPCH & LANG. PATH LICENS
NYM12492Medicare ID - Type UnspecifiedBLUE CROSS ID NUMBER