Healthcare Provider Details

I. General information

NPI: 1982544367
Provider Name (Legal Business Name): JIMMY SEGOVIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S BROADWAY
YONKERS NY
10701-4006
US

IV. Provider business mailing address

3246 84TH ST
EAST ELMHURST NY
11370-2010
US

V. Phone/Fax

Practice location:
  • Phone: 914-378-7000
  • Fax:
Mailing address:
  • Phone: 164-624-3893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: