Provider Demographics
NPI:1578504890
Name:SIEGEL, STACEY BETH (DO)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BETH
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 ARLENE CT
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1112
Mailing Address - Country:US
Mailing Address - Phone:973-218-9877
Mailing Address - Fax:
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:STE 107
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-586-8400
Practice Address - Fax:973-586-4206
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB059047207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG30427Medicare UPIN
NJ881366Medicare ID - Type Unspecified