Provider Demographics
NPI:1124088778
Name:SELINA SEGAL, NATALYA (DO)
Entity type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:SELINA SEGAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NATALYA
Other - Middle Name:
Other - Last Name:SELINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:722 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2435
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2099
Practice Address - Street 1:100 JOHN ROEMMELT DR
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8301
Practice Address - Country:US
Practice Address - Phone:607-739-0352
Practice Address - Fax:607-739-6909
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0096521Medicaid
NJP00342318OtherRR MEDICARE
NJ095471TN1Medicare ID - Type Unspecified
NJI44352Medicare UPIN
NJ0096521Medicaid