Provider Demographics
NPI:1700954807
Name:SIEGEL, ALICE JO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:JO
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:119 EAST 83RD STREET
Mailing Address - Street 2:APT 1A
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-831-8403
Mailing Address - Fax:914-381-4157
Practice Address - Street 1:119 EAST 83RD STREET
Practice Address - Street 2:APT 1A
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-831-8403
Practice Address - Fax:914-381-4157
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135-323-12084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3357198OtherOXFORD
NY01771782Medicaid
NYB78975Medicare ID - Type Unspecified
NY01771782Medicaid