Healthcare Provider Details

I. General information

NPI: 1548156169
Provider Name (Legal Business Name): JESSE SEGAL PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 ORRS MILLS RD
NEW WINDSOR NY
12553-8804
US

IV. Provider business mailing address

610 ORRS MILLS RD
NEW WINDSOR NY
12553-8804
US

V. Phone/Fax

Practice location:
  • Phone: 845-913-6857
  • Fax:
Mailing address:
  • Phone: 845-913-6857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF407049-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number714983-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: