Healthcare Provider Details

I. General information

NPI: 1821148453
Provider Name (Legal Business Name): MICHAEL SIEGELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 PARK AVE STE C
NEW YORK NY
10021-4252
US

IV. Provider business mailing address

PO BOX 386
NEW YORK NY
10276-0386
US

V. Phone/Fax

Practice location:
  • Phone: 646-322-7434
  • Fax:
Mailing address:
  • Phone: 646-322-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number231338
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: