MEDICARE: DR. INARA K SEGAL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	35SI00171300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IP030586	OTHER	NJ	MAGELLAN
2	105663	OTHER	NJ	MHN
3	35SI00171300	OTHER	NJ	PSYCHOLOGIST LICENSE #
4	IS130	OTHER		OXFORD ID

General Provider Information

NPI Number	:	1093729303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INARA K SEGAL PH.D.

Provider Business Mailing Address
First Line	:	1250 ROUTE 23 NORTH
Second Line	:	SUITE 5
City	:	BUTLER
State	:	NJ
Zip	:	07405-2002
Country	:	US
Telephone Number	:	973-492-8700
Fax Number	:	973-492-7670

Provider Business Practice Location Address
First Line	:	1250 ROUTE 23 NORTH
Second Line	:	SUITE 5
City	:	BUTLER
State	:	NJ
Zip	:	07405-2002
Country	:	US
Telephone Number	:	973-492-8700
Fax Number	:	973-492-7670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/08/2007

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