Provider Demographics
NPI:1245414630
Name:SEGAL, NADAV (DDS)
Entity Type:Individual
Prefix:DR
First Name:NADAV
Middle Name:
Last Name:SEGAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 OLD TOWN RD
Mailing Address - Street 2:APARTMENT 3P
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2200
Mailing Address - Country:US
Mailing Address - Phone:631-682-5594
Mailing Address - Fax:
Practice Address - Street 1:543A HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1143
Practice Address - Country:US
Practice Address - Phone:516-564-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0525251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics