Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25MA07508600 | NJ |
N | 208600000X | Surgeon | 25MA07508600 | NJ |
Y | 2086S0102X | Surgical Critical Care | 25MA07508600 | NJ |
N | 2086S0127X | Trauma Surgeon | 25MA07508600 | NJ |
NPI | 1477555977 |
---|---|
Provider Name | Dr. Brian K Siegel |
First Address | Basking Ridge, NJ 07920-1502 |
Second Address | Somerville, NJ 08876-2519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0044202 | (05) | NJ |
H75258 | (02) | NJ |