Provider Demographics
NPI:1336220516
Name:SIEGEL, HOWARD JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:JEFFREY
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3233
Mailing Address - Country:US
Mailing Address - Phone:516-599-6100
Mailing Address - Fax:
Practice Address - Street 1:120 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3233
Practice Address - Country:US
Practice Address - Phone:516-599-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002413-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX13861Medicare ID - Type Unspecified
T52070Medicare UPIN