Provider Demographics
NPI:1184622763
Name:SIEGEL, WENDY S (DPM)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E MIDDLE COUNTRY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2814
Mailing Address - Country:US
Mailing Address - Phone:631-265-7777
Mailing Address - Fax:631-265-7778
Practice Address - Street 1:222 E MIDDLE COUNTRY RD STE 200
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2814
Practice Address - Country:US
Practice Address - Phone:631-265-7777
Practice Address - Fax:631-265-7778
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2021-07-27
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
NYN005995213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPJ6511Medicare UPIN
NY5484310001Medicare NSC