Healthcare Provider Details

I. General information

NPI: 1386647675
Provider Name (Legal Business Name): ALAN L. SIEGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 STATE ROUTE 19 N
WARSAW NY
14569-9336
US

IV. Provider business mailing address

2469 STATE ROUTE 19 N
WARSAW NY
14569-9336
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-2288
  • Fax: 585-786-3699
Mailing address:
  • Phone: 585-786-2288
  • Fax: 585-786-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number182162
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: