Provider Demographics
NPI:1699866871
Name:SEGAL, ILIA (MD)
Entity type:Individual
Prefix:
First Name:ILIA
Middle Name:
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 1:2333 MORRIS AVENUE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5746
Mailing Address - Country:US
Mailing Address - Phone:908-964-1964
Mailing Address - Fax:908-964-6286
Practice Address - Street 1:2333 MORRIS AVENUE
Practice Address - Street 2:SUITE A1
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5746
Practice Address - Country:US
Practice Address - Phone:908-964-1964
Practice Address - Fax:908-964-6286
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03979600207RC0200X, 207R00000X
NJMA39796207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1147901Medicaid
NJC59806Medicare UPIN
NJ1147901Medicaid