Provider Demographics
NPI:1457412892
Name:KLEIN-SIEGELSON, ROBERTA A (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:A
Last Name:KLEIN-SIEGELSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2786 ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2607
Mailing Address - Country:US
Mailing Address - Phone:516-510-3813
Mailing Address - Fax:
Practice Address - Street 1:1 S MARION PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5300
Practice Address - Country:US
Practice Address - Phone:516-415-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist