Provider Demographics
NPI:1316084189
Name:SEGAL, MICHELE ROBYN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ROBYN
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 WASHINGTON AVE
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3935
Mailing Address - Country:US
Mailing Address - Phone:973-235-9449
Mailing Address - Fax:
Practice Address - Street 1:187 WASHINGTON AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3935
Practice Address - Country:US
Practice Address - Phone:973-235-9449
Practice Address - Fax:973-235-0434
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA077685002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine