Healthcare Provider Details

I. General information

NPI: 1780652990
Provider Name (Legal Business Name): JEFFREY LOREN SEGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E NORTHFIELD RD FL 3
LIVINGSTON NJ
07039-4896
US

IV. Provider business mailing address

150 FLORAL AVE
NEW PROVIDENCE NJ
07974-1557
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-9998
  • Fax:
Mailing address:
  • Phone: 908-588-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA06957000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MA06957000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: