Healthcare Provider Details

I. General information

NPI: 1013905835
Provider Name (Legal Business Name): NAWAL SIAGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 35TH ST
ASTORIA NY
11103-4702
US

IV. Provider business mailing address

3066 35TH ST
ASTORIA NY
11103-4702
US

V. Phone/Fax

Practice location:
  • Phone: 718-278-1919
  • Fax: 718-278-7516
Mailing address:
  • Phone: 718-278-1919
  • Fax: 718-278-7516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number130130
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number130130
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: