Healthcare Provider Details

I. General information

NPI: 1144922758
Provider Name (Legal Business Name): AMANDA SEGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N DIVISION ST
PEEKSKILL NY
10566-2944
US

IV. Provider business mailing address

22 N DIVISION ST
PEEKSKILL NY
10566-2944
US

V. Phone/Fax

Practice location:
  • Phone: 914-566-9608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number065754
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03140000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: