1760446389 NPI number — DR. DONALD P SEGAL DPM

Table of content: DR. DONALD P SEGAL DPM (NPI 1760446389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760446389 NPI number — DR. DONALD P SEGAL DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGAL
Provider First Name:
DONALD
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1760446389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 ORANGE AVE
Provider Second Line Business Mailing Address:
PO BOX 328
Provider Business Mailing Address City Name:
WALDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-778-2387
Provider Business Mailing Address Fax Number:
845-778-2404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 ORANGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALDEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-778-2387
Provider Business Practice Location Address Fax Number:
845-778-2404
Provider Enumeration Date:
04/12/2006

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: 213E00000X , with the licence number:  N3124 , 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)

  • Identifier: 00587164 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2626079 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00749018 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0094649 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02730165 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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