Provider Demographics
NPI:1952459471
Name:SEGAL, JAY LOUIS (MED)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:LOUIS
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1420 LOCUST ST
Mailing Address - Street 2:APT. 27D
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4223
Mailing Address - Country:US
Mailing Address - Phone:215-563-2882
Mailing Address - Fax:215-563-2028
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:STE. 1128
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-563-2882
Practice Address - Fax:215-563-2028
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS003584-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist