Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N005995 | NY |
NPI | 1184622763 |
---|---|
Provider Name | Wendy S Siegel |
First Address | Smithtown, NY 11787-2814 |
Second Address | Smithtown, NY 11787-2814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 27/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PJ6511 | (02) | NY |