Provider Demographics
NPI:1922066125
Name:SIEMINSKI, DOUGLAS P (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:P
Last Name:SIEMINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:404 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:33 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2764
Practice Address - Country:US
Practice Address - Phone:973-383-2244
Practice Address - Fax:973-383-0448
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMB07893100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095643Medicare ID - Type Unspecified