Provider Demographics
NPI:1871517029
Name:SIEGEL, HOWARD B (PHD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:B
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-5023
Mailing Address - Country:US
Mailing Address - Phone:212-673-2256
Mailing Address - Fax:201-333-9322
Practice Address - Street 1:7 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-5023
Practice Address - Country:US
Practice Address - Phone:212-673-2256
Practice Address - Fax:201-333-9322
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003597-1103TC0700X
NJ2771103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003597-1OtherNEW YORK LICENSE NO.
NJ2771OtherLICENSE NO.
NY003597-1OtherNEW YORK LICENSE NO.