Healthcare Provider Details

I. General information

NPI: 1659376036
Provider Name (Legal Business Name): TIMOTHY J SIGLOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 HILL BLVD CAREMOUNT MEDICAL PC
JEFFERSON VALLEY NY
10535-1500
US

IV. Provider business mailing address

110 S BEDFORD RD CAREMOUNT MEDICAL PC
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-1050
  • Fax: 914-245-7836
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-245-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number165043
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: