Healthcare Provider Details

I. General information

NPI: 1124088778
Provider Name (Legal Business Name): NATALYA SELINA SEGAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALYA SELINA DO

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JOHN ROEMMELT DR
HORSEHEADS NY
14845-8301
US

IV. Provider business mailing address

722 W WATER ST
ELMIRA NY
14905-2435
US

V. Phone/Fax

Practice location:
  • Phone: 607-739-0352
  • Fax: 607-739-6909
Mailing address:
  • Phone: 607-271-2050
  • Fax: 607-271-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number236822
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: