Provider Demographics
NPI:1780652990
Name:SEGAL, JEFFREY LOREN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LOREN
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 1:150 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1557
Mailing Address - Country:US
Mailing Address - Phone:908-588-3890
Mailing Address - Fax:
Practice Address - Street 1:315 E NORTHFIELD RD
Practice Address - Street 2:FL 3
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4896
Practice Address - Country:US
Practice Address - Phone:973-322-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06957000207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ562480070Medicaid
NJ562480070Medicaid
NJ086147TJ1Medicare PIN