Healthcare Provider Details

I. General information

NPI: 1629992441
Provider Name (Legal Business Name): NATHAN SISKEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 CENTRAL AVE
NEEDHAM MA
02492-1410
US

IV. Provider business mailing address

13 STORY ST APT 2E
CAMBRIDGE MA
02138-4964
US

V. Phone/Fax

Practice location:
  • Phone: 781-292-0154
  • Fax: 781-292-2197
Mailing address:
  • Phone: 847-420-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: