Provider Demographics
NPI:1760446389
Name:SEGAL, DONALD P (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:SEGAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ORANGE AVE
Mailing Address - Street 2:PO BOX 328
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586
Mailing Address - Country:US
Mailing Address - Phone:845-778-2387
Mailing Address - Fax:845-778-2404
Practice Address - Street 1:13 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586
Practice Address - Country:US
Practice Address - Phone:845-778-2387
Practice Address - Fax:845-778-2404
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3124213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00587164Medicaid
NYP2626079OtherOXFORD
P00749018OtherRAILROAD MEDICARE
NY0094649OtherGHI
NY02730165Medicaid
NY02730165Medicaid
P00749018OtherRAILROAD MEDICARE
P34152Medicare PIN
P34153Medicare PIN
NY0094649OtherGHI
T51004Medicare UPIN