MEDICARE: DR. MARISA SIEBEL M.D.

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	207RX0202X	Medical Oncology Physician	240929	NY

General Provider Information

NPI Number	:	1942303094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISA SIEBEL M.D.

Provider Business Mailing Address
First Line	:	440 MAIN STREET
Second Line	:	NORTHWELL HEALTH CANCER INSTITUTE, IMBERT CANCER CENTER
City	:	BAY SHORE
State	:	NY
Zip	:	11706
Country	:	US
Telephone Number	:	631-734-7671
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 LAKEVILLE RD
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1118
Country	:	US
Telephone Number	:	516-734-7671
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	09/14/2016

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