Provider Demographics
NPI:1649275405
Name:SIEDMAN, ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:SIEDMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432
Mailing Address - Street 2:RT 38
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:856-482-2933
Mailing Address - Fax:856-482-2936
Practice Address - Street 1:2432
Practice Address - Street 2:RT 38
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002
Practice Address - Country:US
Practice Address - Phone:856-482-2933
Practice Address - Fax:856-482-2936
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00393600152W00000X
NJ27TO00039500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0797600Medicaid
51436146Medicare ID - Type Unspecified
NJ0797600Medicaid