Provider Demographics
NPI:1972656643
Name:SIEGEL, ESTHER (EDD RN CS)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:EDD RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-691-1702
Mailing Address - Fax:
Practice Address - Street 1:2109 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2138
Practice Address - Country:US
Practice Address - Phone:212-691-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190104-1364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
134114926Medicare UPIN
P12434Medicare ID - Type Unspecified