Provider Demographics
NPI:1811189590
Name:SIEGEL, WILLIAM M (DPT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 SHELDRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1343
Mailing Address - Country:US
Mailing Address - Phone:914-953-8178
Mailing Address - Fax:
Practice Address - Street 1:52 SHELDRAKE AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1343
Practice Address - Country:US
Practice Address - Phone:914-953-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 018564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ28S71Medicare PIN