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General NPI Number Information
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NPI Number | 1902918774
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE SIECZKA M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 630 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10021-6544
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Country | US
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Telephone | 212-439-1600
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Fax | 212-439-6269
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Provider Business Mailing Address
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Address Line | 1272 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2583
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Country | US
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Telephone | 631-663-4020
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Fax | 631-663-4010
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 198698
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License Number State | NY
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