Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 045688-1 | NY |
Y | 1223E0200X | Endodontist | 0456881 | NY |
NPI | 1063744159 |
---|---|
Provider Name | Dr. Gina M Siegel |
First Address | Snyder, NY 14226-4567 |
Second Address | Snyder, NY 14226-4567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2010 |
Last Update Date | 13/01/2020 |