Provider Demographics
NPI:1801980099
Name:SIEGAL, FREDERICK PAUL (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:PAUL
Last Name:SIEGAL
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 1:36 SEVENTH AVENUE, SUITE 512
Mailing Address - Street 2:MOUNT SINAI DOWNTOWN PRACTICE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-604-2940
Mailing Address - Fax:212-604-7281
Practice Address - Street 1:36 SEVENTH AVENUE, SUITE 512
Practice Address - Street 2:MOUNT SINAI DOWNTOWN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-604-6513
Practice Address - Fax:212-604-6579
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00166069Medicaid
95G841Medicare ID - Type Unspecified
NY00166069Medicaid
C11678Medicare UPIN