Healthcare Provider Details

I. General information

NPI: 1316084189
Provider Name (Legal Business Name): MICHELE ROBYN SEGAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 WASHINGTON AVE SUITE 2D
NUTLEY NJ
07110-3935
US

IV. Provider business mailing address

187 WASHINGTON AVE SUITE 2D
NUTLEY NJ
07110-3935
US

V. Phone/Fax

Practice location:
  • Phone: 973-235-9449
  • Fax: 973-235-0434
Mailing address:
  • Phone: 973-235-9449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA07768500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: