Provider Demographics
NPI:1396787388
Name:SIEGEL, AMY MICHELE (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELE
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:MICHELE
Other - Last Name:SELICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 SEARS DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3515
Mailing Address - Country:US
Mailing Address - Phone:201-225-2555
Mailing Address - Fax:201-225-2532
Practice Address - Street 1:1 SEARS DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3515
Practice Address - Country:US
Practice Address - Phone:201-225-2555
Practice Address - Fax:201-225-2532
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06347200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051530V1LMedicare PIN
NJG02834Medicare UPIN