Provider Demographics
NPI:1316058233
Name:SEGAL, TIMOTHY D (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 LEXINGTON AVE
Mailing Address - Street 2:#1H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6218
Mailing Address - Country:US
Mailing Address - Phone:212-501-4284
Mailing Address - Fax:
Practice Address - Street 1:1435 LEXINGTON AVE
Practice Address - Street 2:#1H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6218
Practice Address - Country:US
Practice Address - Phone:212-501-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19644112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04964OtherGHI MEDICARE
P00124234OtherRAILROAD MEDICARE
NY01650040Medicaid
NY04964OtherGHI MEDICARE
NY15J711Medicare ID - Type Unspecified
NY01650040Medicaid