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General NPI Number Information
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NPI Number | 1922363605
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Entity Type | Individual
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Provider Name | LOUIS JARED SIEGEL D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 70 E SUNRISE HWY
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City | VALLEY STREAM
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State | NY
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Zip | 11581-1240
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Country | US
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Telephone | 516-536-5656
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Fax |
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Provider Business Mailing Address
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Address Line | 244 KENT DR
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City | HEWLETT
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State | NY
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Zip | 11557-1813
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Country | US
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Telephone |
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 271946
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 271946
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 271946
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License Number State | NY
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