Provider Demographics
NPI:1922322932
Name:WENDY S. SIEGEL, DPM PLLC
Entity Type:Organization
Organization Name:WENDY S. SIEGEL, DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-312-2214
Mailing Address - Street 1:4 WEIR LN
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1606
Mailing Address - Country:US
Mailing Address - Phone:516-312-2214
Mailing Address - Fax:
Practice Address - Street 1:319 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2819
Practice Address - Country:US
Practice Address - Phone:631-265-7777
Practice Address - Fax:516-676-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005995213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98263Medicare UPIN
PJ6511Medicare PIN
5484310001Medicare NSC