Provider Demographics
NPI:1134673692
Name:SEGAL, MARY ANNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 65TH ST
Mailing Address - Street 2:JGB MENTAL HEALTH & MENTAL RETARDATION SERVICES, INC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6601
Mailing Address - Country:US
Mailing Address - Phone:212-769-6327
Mailing Address - Fax:
Practice Address - Street 1:15 W 65TH ST
Practice Address - Street 2:JGB MENTAL HEALTH & MENTAL RETARDATION SERVICES, INC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6601
Practice Address - Country:US
Practice Address - Phone:212-769-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY495296-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse