Provider Demographics
NPI:1548987712
Name:SIEGEL, NATHAN SAMUEL (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:SAMUEL
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CONNELLY AVE
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-2528
Mailing Address - Country:US
Mailing Address - Phone:845-558-5242
Mailing Address - Fax:
Practice Address - Street 1:89 CONNELLY AVE
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828-2528
Practice Address - Country:US
Practice Address - Phone:845-558-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01091100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist