Healthcare Provider Details

I. General information

NPI: 1861740474
Provider Name (Legal Business Name): CHAIM SIEGEL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 BEACH 13TH ST
FAR ROCKAWAY NY
11691-5506
US

IV. Provider business mailing address

246 BEACH 13TH ST
FAR ROCKAWAY NY
11691-5506
US

V. Phone/Fax

Practice location:
  • Phone: 718-207-3474
  • Fax:
Mailing address:
  • Phone: 718-207-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019727
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: