Healthcare Provider Details

I. General information

NPI: 1063409191
Provider Name (Legal Business Name): WAYNE D SIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/22/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 ROUTE 3 STE 204
SECAUCUS NJ
07094-3857
US

IV. Provider business mailing address

255 ROUTE 3 EAST SUITE 210
SECAUCUS NJ
07094
US

V. Phone/Fax

Practice location:
  • Phone: 201-866-2400
  • Fax: 201-866-0444
Mailing address:
  • Phone: 201-866-2400
  • Fax: 201-866-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMA50168
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: