Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 131654 | NY |
NPI | 1013981380 |
---|---|
Provider Name | Dr. Mark Ira Siegel |
First Address | New York, NY 10010-5423 |
Second Address | New York, NY 10010-5423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00715857 | (05) | NY |
C11871 | (02) |