Provider Demographics
NPI:1285993568
Name:SEGMDPC
Entity type:Organization
Organization Name:SEGMDPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOLDSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-242-6500
Mailing Address - Street 1:420 WEST 23RD STREET
Mailing Address - Street 2:SUITE PB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2172
Mailing Address - Country:US
Mailing Address - Phone:212-242-6500
Mailing Address - Fax:212-242-3111
Practice Address - Street 1:420 WEST 23RD STREET
Practice Address - Street 2:SUITE PB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2172
Practice Address - Country:US
Practice Address - Phone:212-242-6500
Practice Address - Fax:212-242-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142871-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
16D4810Medicare UPIN