MEDICARE: LAWRENCE SEGAL DO

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	207P00000X	Emergency Medicine Physician	MB68502	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659311215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE SEGAL DO

Provider Business Mailing Address
First Line	:	307 S EVERGREEN AVE
Second Line	:
City	:	WOODBURY
State	:	NJ
Zip	:	08096-2739
Country	:	US
Telephone Number	:	856-686-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	218A SUNSET RD
Second Line	:
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-1110
Country	:	US
Telephone Number	:	609-835-3030
Fax Number	:	609-835-3063

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/17/2007

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Directions to “ LAWRENCE SEGAL DO” Practice Location

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