Basic Information
| Provider Information | |||||||||
| NPI: | 1992736680 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SIEGEL | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1617 ROUTE 38 | ||||||||
| Address2: | PINELANDS OB/GYN ASSOC | ||||||||
| City: | LUMBERTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080482919 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1617 ROUTE 38 | ||||||||
| Address2: | PINELANDS OB GYN ASSOCIATES | ||||||||
| City: | LUMBERTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092610240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 04/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MB07342100 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 8766100 | 05 | NJ | MEDICAID |