Provider Demographics
NPI:1174987713
Name:SEIDL, JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:SEIDL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:SEIDL
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:264 LEXINGTON AVE APT 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4182
Mailing Address - Country:US
Mailing Address - Phone:917-561-8889
Mailing Address - Fax:
Practice Address - Street 1:264 LEXINGTON AVE APT 7B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4182
Practice Address - Country:US
Practice Address - Phone:917-561-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-10
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine