Provider Demographics
NPI:1558759118
Name:SEGAL, ROMAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:SEGAL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 E 16TH ST APT 6P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4077
Mailing Address - Country:US
Mailing Address - Phone:917-400-3086
Mailing Address - Fax:
Practice Address - Street 1:2775 E 16TH ST APT 6P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4077
Practice Address - Country:US
Practice Address - Phone:917-400-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037787-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist