Provider Demographics
NPI:1881685378
Name:SEIDEL, STEVEN J (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:SEIDEL
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 1:42 CAMPEAU PL
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3324
Mailing Address - Country:US
Mailing Address - Phone:201-244-0016
Mailing Address - Fax:
Practice Address - Street 1:42 CAMPEAU PL
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3324
Practice Address - Country:US
Practice Address - Phone:201-244-0016
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005671-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01712078Medicaid
NJ7667604Medicaid
NJ015701Medicare ID - Type UnspecifiedNEW JERSEY MEDICARE
NJ7667604Medicaid
NY03076AMedicare ID - Type UnspecifiedGHI MEDICARE
NYCO5501Medicare ID - Type UnspecifiedBC/BS MEDICARE