Healthcare Provider Details

I. General information

NPI: 1972656643
Provider Name (Legal Business Name): ESTHER SIEGEL EDD RN CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 BROADWAY
NEW YORK NY
10023-2138
US

IV. Provider business mailing address

2109 BROADWAY
NEW YORK NY
10023
US

V. Phone/Fax

Practice location:
  • Phone: 212-691-1702
  • Fax:
Mailing address:
  • Phone: 212-691-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number190104-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: