Healthcare Provider Details

I. General information

NPI: 1326217951
Provider Name (Legal Business Name): SS OBGYN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 WALNUT ST STE 101
WELLESLEY HILLS MA
02481-2137
US

IV. Provider business mailing address

70 WALNUT ST STE 101
WELLESLEY HILLS MA
02481-2137
US

V. Phone/Fax

Practice location:
  • Phone: 617-340-6449
  • Fax:
Mailing address:
  • Phone: 617-340-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number82166
License Number StateMA

VIII. Authorized Official

Name: DR. SHIMON SEGAL
Title or Position: PHYSICIAN
Credential: MD
Phone: 617-416-1611