Provider Demographics
NPI:1932185972
Name:SEIGEL, ERIC S (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:SEIGEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3212
Mailing Address - Country:US
Mailing Address - Phone:917-596-1266
Mailing Address - Fax:
Practice Address - Street 1:200 OLD SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5545
Practice Address - Country:US
Practice Address - Phone:917-596-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006809-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
T94016Medicare UPIN
NY571313Medicare ID - Type Unspecified