1336349620 NPI number — LEOPOLDO NICOLAS SEGAL MD

Table of content: LEOPOLDO NICOLAS SEGAL MD (NPI 1336349620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336349620 NPI number — LEOPOLDO NICOLAS SEGAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGAL
Provider First Name:
LEOPOLDO
Provider Middle Name:
NICOLAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336349620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 WRIGHT PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARSDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10583-5309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-306-6208
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
462 1ST AVE
Provider Second Line Business Practice Location Address:
ROOM 7N24
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-9196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-6479
Provider Business Practice Location Address Fax Number:
212-263-8442
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  60 244941 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 244941 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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