Provider Demographics
NPI:1134206253
Name:BACK, SEIGEL & GOLDSTEIN, MD , PA
Entity type:Organization
Organization Name:BACK, SEIGEL & GOLDSTEIN, MD , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-431-1807
Mailing Address - Street 1:501 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-431-1807
Mailing Address - Fax:732-409-2777
Practice Address - Street 1:501 IRON BRIDGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-431-1807
Practice Address - Fax:732-409-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFED TAX ID GROUP #
=========OtherFED TAX ID GROUP #
458306Medicare ID - Type UnspecifiedGROUP #