Healthcare Provider Details

I. General information

NPI: 1295811149
Provider Name (Legal Business Name): CARY S SIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/26/2021
Certification Date: 12/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

6 JESSITAR RD
NORTH SALEM NY
10560-3704
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1426
  • Fax: 718-661-7746
Mailing address:
  • Phone: 917-853-4171
  • Fax: 718-798-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number168309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: