MEDICARE: DANA B SIEGEL DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N005107	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821099904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA B SIEGEL DPM

Provider Business Mailing Address
First Line	:	21 STACEY LN
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2354
Country	:	US
Telephone Number	:	631-206-3106
Fax Number	:	631-206-3108

Provider Business Practice Location Address
First Line	:	2111 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8017
Country	:	US
Telephone Number	:	631-206-3106
Fax Number	:	631-206-3108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	12/26/2012

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