Provider Demographics
NPI:1770733875
Name:SIEGEL, LAWRENCE ALLEN (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8217
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-8217
Mailing Address - Country:US
Mailing Address - Phone:914-478-7536
Mailing Address - Fax:914-478-0378
Practice Address - Street 1:260 E 188TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5302
Practice Address - Country:US
Practice Address - Phone:914-478-7536
Practice Address - Fax:914-478-0378
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068401002084F0202X
NY1409592084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry